Management of tracheostomy: a survey of Dutch intensive care units.
OBJECTIVE
To determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities.


METHODS
We surveyed the physician medical directors of all Dutch nonpediatric ICUs that have > or = 5 beds suitable for mechanical ventilation. The survey asked for demographic information about the hospital and ICU setting, and for information and opinions about tracheostomy management in the ICU and step-down facilities, and the use of tracheostomy-management guidelines.


RESULTS
Forty-four of the 69 ICUs responded. Sixty-four percent of the respondent ICUs only deflate the cuff when the patient is breathing spontaneously, without assistance from the ventilator. Fifty-nine percent do not routinely change the tracheostomy tube. Almost half use inner cannulas in tracheostomy tubes. Overall, intensivists were most often involved in the follow-up of discharged tracheostomized patients. In the nonacademic hospitals, specialized ICU nurses were more often involved (P = .05). Sixty-four percent indicated they have no guideline for managing discharged tracheostomized patients. There was a diversity of opinion (median visual-analog-scale score 5.0, 95% confidence interval 3.0 to 8.0) on whether the tracheostomy tube should be removed "at once" or after "down-sizing."


CONCLUSIONS
There were large differences in tracheostomy management among Dutch ICUs. ICU and post-ICU tracheostomy-management guidelines are lacking and needed.
Veelo
Denise P
DP
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.p.veelo@amc.uva.nl
Schultz
Marcus J
MJ
Phoa
Kai Y N
KY
Dongelmans
Dave A
DA
Binnekade
Jan M
JM
Spronk
Peter E
PE
D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012121:Respiration, Artificial; D014139:Tracheostomy