Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

被引:8
|
作者
St-Laurent, Aaron [1 ]
Zielinski, David [2 ,3 ]
Qazi, Adam [4 ]
AlAwadi, Aceel [5 ]
Almajed, Athari [5 ]
Adamko, Darryl J. [6 ]
Alabdoulsalam, Tareq [7 ]
Chiang, Jackie [4 ]
Derynck, Michael [8 ]
Gerdung, Chris [9 ]
Kam, Karen [10 ]
Katz, Sherri L. [11 ,12 ]
MacLusky, Ian [11 ]
Mehta, Kevan [13 ]
Mateos, Dimas [14 ]
Nguyen, The Thanh D. [15 ]
Praud, Jean-Paul [16 ]
Proulx, Frederic [17 ]
Seear, Michael [18 ]
Smith, Mary Jane [19 ]
Wensley, David [18 ]
Amin, Reshma [4 ]
机构
[1] London Hlth Sci Ctr, Dept Paediat, Div Resp Med, Childrens Hosp, 800 Commissioners Rd E, London, ON N6A 5W9, Canada
[2] McGill Univ, Dept Pediat, Div Pediat Respirol, Montreal Childrens Hosp, Montreal, PQ, Canada
[3] McGill Univ, Res Inst, Hlth Ctr, Montreal, PQ, Canada
[4] Hosp Sick Children, Dept Pediat, Div Resp Med, Toronto, ON, Canada
[5] Mubarak Al Kabeer Hosp, Minist Hlth Kuwait, Jabriya, Kuwait
[6] Jim Pattisons Childrens Hosp, Dept Pediat, Div Resp Med, Saskatoon, SK, Canada
[7] Univ Manitoba, Dept Pediat & Child Hlth, Sect Pediat Respirol, HSC Winnipeg Childrens Hosp, Winnipeg, MB, Canada
[8] Queens Univ, Dept Pediat, Kingston Hlth Sci Ctr, Kingston, ON, Canada
[9] Univ Alberta, Stollery Childrens Hosp, Dept Pediat, Div Resp Med, Edmonton, AB, Canada
[10] Alberta Childrens Prov Gen Hosp, Dept Pediat, Sect Resp Med, Calgary, AB, Canada
[11] Univ Ottawa, Dept Pediat, Div Resp Med, Childrens Hosp Eastern Ontario, Ottawa, ON, Canada
[12] Eastern Ontario Res Inst, Childrens Hosp, Ottawa, ON, Canada
[13] McMaster Childrens Hosp, Dept Pediat, Div Respirol, Hamilton, ON, Canada
[14] IWK Hlth Ctr, Dept Pediat Pediat Respirol, Halifax, NS, Canada
[15] CHU St Justine, Div Respirol, Dept Pediat, Montreal, PQ, Canada
[16] Univ Sherbrooke, Dept Pediat, Div Resp Med, Sherbrooke, PQ, Canada
[17] CHUL & Ctr Mere Enfant Soleil, Dept Pediat, Div Respirol, Quebec City, PQ, Canada
[18] Univ British Columbia, Dept Pediat, Div Pediat Resp Med, Vancouver, BC, Canada
[19] Mem Univ Newfoundland, Fac Med, Dept Pediat, St John, NL, Canada
关键词
chronic ventilation; decannulation; pediatric; speaking valve; tracheostomy; HOME MECHANICAL VENTILATION; PATIENT SAFETY; DECANNULATION; MANAGEMENT; EDUCATION; OUTCOMES; POLYSOMNOGRAPHY; IMPLEMENTATION; CAREGIVERS; REDUCTION;
D O I
10.1002/ppul.26171
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objectives To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. Methods A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. Results The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona (TM) (17/17) and Shiley (TM) (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. Conclusion Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.
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收藏
页码:140 / 151
页数:12
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