PDF(Pubmed)
Abstract：
BACKGROUND: Tracheostomy-related acquired pressure injuries (TRPIs) are one of the hospital-acquired conditions. We hypothesize that an uneven ventilator circuit load, leading to non-neutral tracheostomy tube positioning in the immediate post-tracheostomy period, leads to an increased incidence of TRPIs. Does switching the ventilator circuit load daily, in addition to standard post-tracheostomy care, lead to a decreased incidence of TRPIs?
METHODS: This is a prospective quality improvement study. Study was conducted at two academic hospital sites within tertiary care hospitals at Emory University in different ICUs. Consecutive patients undergoing bedside percutaneous tracheostomy by the interventional pulmonary service were included. The flip the ventilator circuit (FLIC) protocol was designed and implemented in selected ICUs, with other ICUs as controls.
RESULTS: Incidence of TRPI in intervention and control group were recorded at post-tracheostomy day 5. A total of 99 patients were included from October 22, 2019, to May 22, 2020. Overall, the total incidence of any TRPI was 23% at post-tracheostomy day 5. Incidence of stage I, stage II, and stages III-IV TRPIs at postoperative day 5 was 11%, 12%, and 0%, respectively. There was a decrease in the rate of skin breakdown in patients following the FLIC protocol when compared with standard of care (13% vs. 36%; p = 0.01). In a multivariable analysis, interventional group had decreased odds of developing TRPI (odds ratio, 0.32; 95% CI, 0.11-0.92; p = 0.03) after adjusting for age, albumin, body mass index, diabetes mellitus, and days in hospital before tracheostomy.
CONCLUSIONS: The incidence of TRPIs within the first week following percutaneous tracheostomy is high. Switching the side of the ventilator circuit to evenly distribute load, in addition to standard bundled tracheostomy care, may decrease the overall incidence of TRPIs.
METHODS: This is a prospective quality improvement study. Study was conducted at two academic hospital sites within tertiary care hospitals at Emory University in different ICUs. Consecutive patients undergoing bedside percutaneous tracheostomy by the interventional pulmonary service were included. The flip the ventilator circuit (FLIC) protocol was designed and implemented in selected ICUs, with other ICUs as controls.
RESULTS: Incidence of TRPI in intervention and control group were recorded at post-tracheostomy day 5. A total of 99 patients were included from October 22, 2019, to May 22, 2020. Overall, the total incidence of any TRPI was 23% at post-tracheostomy day 5. Incidence of stage I, stage II, and stages III-IV TRPIs at postoperative day 5 was 11%, 12%, and 0%, respectively. There was a decrease in the rate of skin breakdown in patients following the FLIC protocol when compared with standard of care (13% vs. 36%; p = 0.01). In a multivariable analysis, interventional group had decreased odds of developing TRPI (odds ratio, 0.32; 95% CI, 0.11-0.92; p = 0.03) after adjusting for age, albumin, body mass index, diabetes mellitus, and days in hospital before tracheostomy.
CONCLUSIONS: The incidence of TRPIs within the first week following percutaneous tracheostomy is high. Switching the side of the ventilator circuit to evenly distribute load, in addition to standard bundled tracheostomy care, may decrease the overall incidence of TRPIs.
摘要：
背景：气管造口术相关的获得性压力损伤（TRPI）是医院获得性疾病之一。我们假设呼吸机电路负载不均匀，导致非中性气管切开导管在气管切开后即刻定位，导致TRPI的发生率增加。是否每天切换呼吸机电路负载，除了标准的气管造口术后护理，
方法：这是一项前瞻性质量改进研究。研究是在不同ICU的埃默里大学三级护理医院的两个学术医院进行的。包括通过介入性肺部服务进行床边经皮气管切开术的连续患者。在选定的ICU中设计并实现了翻转呼吸机电路(FLIC)协议，与其他ICU作为控制。
结果：在气管造口术后第5天记录干预组和对照组的TRPI发生率。从2019年10月22日至2020年5月22日，共纳入99名患者。总的来说,在气管切开术后第5天,任何TRPI的总发生率为23%.第一阶段的发病率，第二阶段,术后第5天III-IV期TRPI为11%，12%,0%,分别。与标准护理相比，遵循FLIC方案的患者皮肤破裂率有所下降(13%vs.36%；p=0.01）。在多变量分析中，介入组发生TRPI的几率降低(比值比，0.32；95%CI，0.11-0.92；p=0.03)调整年龄后，白蛋白,身体质量指数,糖尿病,气管造口术前在医院待了几天.
结论：经皮气管切开术后第一周内TRPI的发生率很高。切换通风机电路侧，使负载均匀分布，除了标准的捆绑气管切开术护理，可能会降低TRPI的总体发生率。
方法：这是一项前瞻性质量改进研究。研究是在不同ICU的埃默里大学三级护理医院的两个学术医院进行的。包括通过介入性肺部服务进行床边经皮气管切开术的连续患者。在选定的ICU中设计并实现了翻转呼吸机电路(FLIC)协议，与其他ICU作为控制。
结果：在气管造口术后第5天记录干预组和对照组的TRPI发生率。从2019年10月22日至2020年5月22日，共纳入99名患者。总的来说,在气管切开术后第5天,任何TRPI的总发生率为23%.第一阶段的发病率，第二阶段,术后第5天III-IV期TRPI为11%，12%,0%,分别。与标准护理相比，遵循FLIC方案的患者皮肤破裂率有所下降(13%vs.36%；p=0.01）。在多变量分析中，介入组发生TRPI的几率降低(比值比，0.32；95%CI，0.11-0.92；p=0.03)调整年龄后，白蛋白,身体质量指数,糖尿病,气管造口术前在医院待了几天.
结论：经皮气管切开术后第一周内TRPI的发生率很高。切换通风机电路侧，使负载均匀分布，除了标准的捆绑气管切开术护理，可能会降低TRPI的总体发生率。
