Tracheostomy (Warrenville, Ill.)最新文献

Objective: To explore the lived experiences of individuals with tracheostomies, their caregivers, and healthcare professionals to identify challenges and inform patient-centered care efforts.

Study design: A qualitative survey with thematic analysis.

Setting: Global Tracheostomy Collaborative learning community.

Methods: Participants were recruited via a purposive online survey featuring open-ended questions designed to capture diverse stakeholder perspectives. A phenomenological approach within a constructivist-interpretivist paradigm guided the study, employing the International Classification of Functioning framework to examine biopsychosocial dimensions of tracheostomy care. Thematic analysis followed Braun and Clarke's six-phase methodology, with independent coding, iterative refinement, reflexive journaling, triangulation, and peer debriefing.

Results: A total of 191 participants from 17 countries contributed to the study, revealing three overarching themes. (1) Tracheostomy as Lifeline and Vulnerability: Participants described tracheostomy as life-saving yet associated with social isolation, communication barriers, stigma, and supply shortages. (2) Dual-Sided Risk Perceptions: Individuals expressed fears about infection risks and stigma, while caregivers and healthcare professionals highlighted concerns about tracheostomy as a potential transmission risk. (3) Disrupted Care and Team Function: Challenges included limited multidisciplinary support, restricted access to critical supplies, and constrained care protocols, which affected patient and caregiver safety and well-being.

Conclusion: Tracheostomy patients face compounded vulnerabilities, highlighting the need for holistic, patient-centered care models that address physical, social, and emotional challenges. Inclusive and adaptive healthcare practices are essential to mitigate risks, reduce stigma, and enhance the quality of life for individuals with a tracheostomy and caregivers, especially during healthcare crises.

Tracheostomy care spans critical care, rehabilitation, and community settings, requiring collaboration among clinicians, patients, and families. The International Council of Nurses' (ICN) 2025 definitions of nursing and a nurse provide a timely framework for advancing this continuum, emphasizing equity, health literacy, cultural safety, and shared accountability. These principles align with the mission of the Global Tracheostomy Collaborative, which promotes interprofessional teamwork, caregiver engagement, and data-driven quality improvement. Within this model, nurses serve as system integrators, working with patients and professionals in safeguarding airway management, supporting transitions, and empowering families with knowledge and confidence. Evidence demonstrates that structured protocols, discharge planning, and caregiver training reduce complications, disparities, and readmissions. Globally, nurses are also critical team members who drive innovation in resource-limited settings, adapting protocols and educational strategies to community needs. By situating tracheostomy care within the ICN framework, we highlight the central role of nurses as autonomous practitioners and collaborative partners. Specific examples illustrate this continuum. The renewed definitions reinforce that tracheostomy safety and dignity depend not on isolated tasks, but on coordinated, culturally responsive systems of care. This shared language affirms recognition of contributions of all health professional engaged in interprofessional collaboration, thereby offering a global vision for safer, more equitable outcomes across the tracheostomy journey.

Individuals living with tracheostomies represent a medically complex population whose outcomes have measurably improved through innovations driven by academic medicine and publicly funded research. A growing body of high-quality evidence demonstrates that multidisciplinary tracheostomy teams, standardized care protocols, and interprofessional education can reduce complications, shorten hospital stays, enhance communication, and improve quality of life. However, the lifeline for innovation and care in communities is supported by public investment in federal research grants and programs like Medicaid, the principal insurer for many individuals requiring long-term tracheostomy care. Reducing this lifeline amplifies risks for children, adults, individuals with disabilities, particularly those in rural or socioeconomically disadvantaged communities. The prospect of stark reductions in NIH indirect cost funding and sweeping cuts to Medicaid jeopardize both the infrastructure of clinical research and the care pathways it has enabled. This editorial explores the rationale for preventing disinvestment, which not only endangers current standards of care but also undermines decades of investigative research that has tangibly advanced patient outcomes. Sustained progress depends on protecting the ecosystem that links federally funded science to equitable, high-quality care. In the face of growing policy headwinds, a renewed national commitment to evidence-based investment in research and coverage is the best hope for patients for whom innovation is essential.

Although the ethical imperative to respond to medical errors that cause patient harm is well established, reporting errors that span institutional boundaries introduces added ethical, professional, and practical challenges. This article examines these tensions through the fictitious case of a patient who had repeated tracheostomy dislodgement, highlighting the responsibilities of healthcare professionals to maintain transparency, foster trust, and promote systemic quality improvement. While disclosing errors to patients and families is widely recognized as essential to ethical and patient-centered care, reporting mistakes made by colleagues, especially across healthcare systems, raises issues of professional responsibility, institutional accountability, and medicolegal risk. Healthcare professionals must navigate considerations of individual accountability versus systemic failure to support a culture of learning. In high-risk settings such as tracheostomy care, adverse events often arise from both human error and systemic deficiencies, underscoring the need for structured reporting mechanisms that support ethical disclosure, interprofessional communication, and data-driven quality improvement. This discussion highlights the evolving expectations for professional self-regulation, the role of structured feedback in improving care, and the ethical imperative to protect future patients while maintaining fairness to colleagues. Advancing patient safety is thus predicated on strengthening institutional policies and fostering a culture of accountability without instilling fear or inappropriately attributing blame. A just culture approach, emphasizing learning, transparency, and systemic improvement, provides a pathway to reconciling ethical obligations with practical solutions, ensuring the highest standards of care.

Tracheostomy care is a critical aspect of airway management, yet persistent gaps in provider training, patient education, and healthcare accessibility contribute to inconsistent clinical outcomes. Innovative technologies offer the promise of accelerated learning and scalable interventions. Artificial intelligence (AI), simulation, and digital health solutions have transformative potential for bridging these deficiencies. This article explores the integration of AI-driven technologies in tracheostomy education, workforce development, telehealth, predictive analytics, and robotic-assisted airway management. AI-powered learning platforms, including virtual reality simulations and conversational AI, enhance skill acquisition and clinical confidence, addressing significant competency deficits. Telehealth solutions, augmented by AI-driven monitoring and decision-support systems, can improve follow-up care, reduce hospitalizations, and expand patient access to expert consultation. Additionally, predictive analytics and machine learning models can optimize tracheostomy placement, complication prevention, and long-term patient outcomes, while robotic-assisted airway interventions demonstrate potential for enhanced procedural precision. Despite these advancements, challenges such as algorithm transparency, content readability, and human oversight must be addressed to maximize AI's effectiveness. As AI continues to evolve, future research should focus on refining these technologies, ensuring ethical implementation, and integrating AI solutions into standardized clinical workflows to enhance patient safety and healthcare efficiency.

Objective: To identify gaps in tracheostomy care related to education, workforce competency, access, affordability, and caregiver empowerment, and to provide actionable insights for improving global tracheostomy practices.

Design: Cross-sectional, descriptive study utilizing a global multi-stakeholder survey.

Methods: A 19-item survey, developed collaboratively with healthcare professionals (HCPs), patients, and caregivers, was distributed to members of the Global Tracheostomy Collaborative. Respondents rated tracheostomy care challenges on a severity scale and provided qualitative insights. Quantitative data were analyzed descriptively, while qualitative data were stratified by stakeholder group and thematically synthesized.

Results: A total of 170 respondents from 14 countries and diverse professional roles, including speech-language pathologists (30%), nurses (24%), and respiratory care practitioners (24%), identified major challenges. The most critical issues included limited availability of HCPs with tracheostomy expertise (median severity score: 8), inequities in access to care (7), and affordability concerns (6). Key themes included inadequate education and training, inconsistent suctioning and stoma care techniques, and insufficient caregiver empowerment. Barriers specific to underserved populations and resource-limited settings included geographic access limitations, financial strain, and workforce shortages. Respondents emphasized the need for standardized training, simulation-based education, telehealth solutions, and equitable resource allocation to improve care delivery.

Conclusion: This study highlights significant challenges in global tracheostomy care and emphasizes the need for targeted interventions, such as innovative training frameworks, standardized care pathways, and policy-level changes to address systemic inequities. Enhanced interdisciplinary collaboration and patient-centered approaches are critical for improving outcomes and reducing caregiver burden. Future efforts must prioritize scalable solutions to bridge gaps in underserved and resource-constrained settings.

Aim: To evaluate the effectiveness of AvTrach^® wearable artificial airway simulators (AWAS) compared to high-fidelity manikins (HFM) in enhancing tracheostomy suctioning competency, managing physiological stress, and improving engagement through dimensions of physical, conceptual, and psychological fidelity.

Design: A multi-institutional, randomized controlled trial (RCT) was conducted to compare AWAS with HFM training modalities for tracheostomy suctioning among healthcare professionals and students.

Methods: Participants (n = 69) from two institutions were randomized into experimental (AWAS) and control (HFM) groups. Competency was assessed using an Objective Structured Clinical Examination tool, and stress responses were measured through salivary cortisol levels. The study encompassed four sessions: recruitment, baseline competency levels and training, simulation, and clinical demonstrations. Quantitative data were analyzed using descriptive statistics, Wilcoxon rank-sum tests, and mixed-effects regression models.

Results: Both groups demonstrated improved competency post-training (p < 0.001). However, the AWAS group achieved higher clinical competency scores (p < 0.001) and exhibited stable cortisol levels during clinical demonstrations, indicating better stress adaptation. Participants in the AWAS group also reported higher engagement, attributed to dynamic feedback and enhanced emotional immersion.

Conclusion: AWAS training, integrating physical, conceptual, and psychological fidelity, significantly enhances tracheostomy care competency and stress management compared to HFM. This approach supports technical skill development, emotional preparedness, and interprofessional collaboration, essential for high-stakes clinical environments.

Background: Tracheostomy is a life-saving procedure associated with complex long-term care needs and potential complications, including stoma infections, respiratory challenges, and impaired quality of life (QoL). While follow-up care is widely recommended, its impact on adherence to maintenance practices, clinical outcomes, and long-term recovery has not been thoroughly evaluated.

Objectives: This study examined the influence of follow-up care on tracheostomy management, adherence to care routines, clinical outcomes, and QoL three months and three-years post-discharge. Key objectives included assessing adherence to stoma cleaning and tube changes, evaluating complication rates, tracheostomy retention, and analyzing QoL outcomes in patients who received follow-up care compared to those who did not.

Methods: A longitudinal cohort study was conducted at The Johns Hopkins Hospital, including 220 adult patients who underwent tracheostomy between 2007 and 2017. Data were collected through electronic health records and structured telephone surveys. Primary outcomes included adherence to maintenance practices, clinical complications, and health-related quality of life (HRQoL) measured using the SF-8 Health Survey. Statistical analyses included chi-square tests, t-tests, and multivariate regression.

Results: Among 220 patients who completed the study, 166 (75.5%) received follow-up care. Patients with follow-up care demonstrated significantly higher adherence to stoma cleaning protocols (p = 0.001), although tube change frequency did not differ between groups (p = 0.37). Follow-up care was associated with more frequent identification of complications, including stoma infections (7.8% vs. 1.9%, p = 0.11) and respiratory difficulties (39.1% vs. 22.2%, p = 0.05). However, these differences were not statistically significant except for breathing difficulties. HRQoL analyses revealed marginally lower physical component scores (PCS) in the follow-up group (44.4 vs. 48.0, p = 0.03), while mental component scores (MCS) were comparable between groups (42.1 vs. 42.8, p = 0.66). At three years post-discharge, tracheostomy tube retention was low (6.8%), with stenosis being the most common reason for long-term tracheostomy dependence. Follow-up care was associated with a higher likelihood of timely tracheostomy tube removal and improved cosmetic outcomes.

Conclusions: Follow-up care plays a critical role in improving adherence to tracheostomy maintenance and ensuring timely management of complications. However, disparities in QoL outcomes and care protocols highlight the need for standardized, multidisciplinary follow-up systems. Future research should explore scalable interventions, such as telehealth, to optimize care for tracheostomy patients and address barriers to equitable access.

Introduction: Tracheostomy is frequently performed in neurocritical patients to facilitate airway management and ventilator liberation. However, the optimal timing of tracheostomy remains controversial, particularly in stroke patients, where earlier intervention may impact recovery and healthcare resource utilization. This study evaluates the association between early (<14 days) versus late (>14 days) tracheostomy and key clinical outcomes in stroke and non-stroke neurocritical care patients.

Methods: A retrospective cohort study was conducted in a neuro-intensive care unit at an urban, quaternary care hospital. Adult patients (≥18 years) who underwent both percutaneous tracheostomy and gastrostomy between 2007 and 2013 were included. Demographics, admission Glasgow Coma Scale (GCS), hospital and intensive care unit (ICU) length of stay (LOS), ventilator days, reintubation rates, tracheostomy-related complications, costs, and discharge disposition were compared between stroke and non-stroke patients, as well as between early and late tracheostomy groups. Multivariable regression and competing risks models were used to adjust for confounders.

Results: Among 290 patients (145 stroke, 145 non-stroke), early tracheostomy was associated with significantly shorter ICU LOS (21.7 vs. 27.6 days, p < 0.01), reduced hospital LOS (32.4 vs. 38.9 days, p < 0.01), and lower total hospital costs ($121,645 vs. $157,304, p < 0.01) in stroke patients. Late tracheostomy was associated with a 2.7-fold increase in reintubation risk (p = 0.02) and 40% lower likelihood of discharge to rehabilitation (p < 0.01). In non-stroke patients, late tracheostomy was linked to longer ICU LOS (35.5 vs. 22.1 days, p < 0.01), extended hospitalization (50.8 vs. 32 days, p < 0.01), and increased costs ($206,184 vs. $128,788, p < 0.01). Tracheostomy-related complications were more frequent in early tracheostomy stroke patients (22.1% vs. 7.3%, p = 0.03), but this did not impact overall discharge outcomes.

Conclusions: Early tracheostomy in neurocritical patients, particularly those with stroke, is associated with shorter ICU stays, lower reintubation rates, and improved discharge to rehabilitation. While early tracheostomy carries a higher risk of procedural complications, its benefits in ICU efficiency and recovery support its role in evidence-based airway management strategies. Future prospective studies should focus on refining patient selection criteria for early tracheostomy and evaluating long-term functional outcomes in neurocritical care populations.

Introduction: Tracheostomy involves complex, resource-intensive care. Yet, few data about the procedure-related cost burden for patients and their families are available. Passage of the No Surprises Act has been associated with changes in patient billing for certain healthcare services, but data on tracheostomy have not been investigated.

Methods: We conducted a retrospective cohort study using the Merative MarketScan database for commercially insured patients aged 18-64 who underwent tracheostomy from 2014-2022 in the United States. We estimated out-of-pocket (OOP) costs (sum of deductibles, copay, and coinsurance) and potential surprise bills (an out-of-network claim where both the primary surgeon and facility were in-network) within 30 days of surgery. Relationships between OOP costs, potential surprise bills, and patient- and system-level exposures were analyzed.

Results: Among 8,950 patients who underwent tracheostomy, the mean (SD) age was 49.3 (12.7) years; most patients were male (61.8%) and had fee-for-service based insurance (79.8%). The mean (SD) total OOP cost attributable to tracheostomy was $1,423 (2,029), and coinsurance accounted for 62.8% of these costs. Potential surprise bills were present in 9.1% of surgical episodes overall and were associated with higher OOP costs (mean (SD) $1909 (2433) vs. $1444 (2021); p<0.001)). High-deductible health plans and fee-for-service based plans were the largest predictors for overall OOP costs (cost ratio 2.66 and 1.84, respectively; p<0.001 for both) and potential surprise bills (odds ratio 2.07 and 2.78, respectively; p<0.001 for both). The incidence of potential surprise bills diminished over the course of the study period.

Conclusions: Patients undergoing tracheostomy have significant exposure to OOP costs, predominantly attributable to coinsurance, with potential surprise bills representing an additional source of cost exposure. These findings highlight the need for financial counseling and policy reform to reduce patient cost burdens.