title: Clinical consensus statement: tracheostomy care.
abstract: OBJECTIVE
  This clinical consensus statement (CCS) aims to improve care for pediatric and adult patients with a tracheostomy tube. Approaches to tracheostomy care are currently inconsistent among clinicians and between different institutions. The goal is to reduce variations in practice when managing patients with a tracheostomy to minimize complications.
  
  
  METHODS
  A formal literature search was conducted to identify evidence gaps and refine the scope of this consensus statement. The modified Delphi method was used to refine expert opinion and facilitate a consensus position. Panel members were asked to complete 2 scale-based surveys addressing different aspects of pediatric and adult tracheostomy care. Each survey was followed by a conference call during which results were presented and statements discussed.
  
  
  RESULTS
  The panel achieved consensus on 77 statements; another 39 were dropped because of lack of consensus. Consensus was reached on statements that address initial tracheostomy tube change, management of emergencies and complications, prerequisites for decannulation, management of tube cuffs and communication devices, and specific patient and caregiver education needs.
  
  
  CONCLUSIONS
  The consensus panel agreed on statements that address the continuum of care, from initial tube management to complications in children and adults with a tracheostomy. The panel also highlighted areas where consensus could not be reached and where more research is needed. This consensus statement should be used by physicians, nurses, and other stakeholders caring for patients with a tracheostomy.
authors.affiliation: Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas 75207, USA. ron.mitchell@utsouthwestern.edu
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.forename: Heather M
authors.initials: HM
authors.lastname: Hussey
authors.forename: Gavin
authors.initials: G
authors.lastname: Setzen
authors.forename: Ian N
authors.initials: IN
authors.lastname: Jacobs
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.forename: Cindy
authors.initials: C
authors.lastname: Dawson
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.forename: Cheryl
authors.initials: C
authors.lastname: Brandt
authors.forename: Kathleen
authors.initials: K
authors.lastname: Deakins
authors.forename: Christopher
authors.initials: C
authors.lastname: Hartnick
authors.forename: Albert
authors.initials: A
authors.lastname: Merati
mesh_terms: D000328:Adult; D058109:Airway Management / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic; D014139:Tracheostomy / Q000592:standards*; D014481:United States