Resultados de aplicar un protocolo de seguridad al paciente traqueotomizado procedente de una unidad de cuidados críticos

Abstract

Introduction and objective: Historically the tracheostomized patient that is moved from a critical care unit (CCU) to a conventional hospitalization floor has had high morbidity and mortality ratio. In 2015 a multidisciplinary protocol about the safety of the tracheostomized patients was set in motion at Hospital Clínico Universitario de Valladolid, based on training, standardization of the patient care and adoption of new strategies.

The aim of this work is to get to know the results of this program implementation.

Method: Prospective cohort and observational study about the monitoring of 150 patients in a third level university hospital lacking a intermediate care unit. We registered and analyzed the clinical and epidemiological variables as well as the evolution after the program’s launch.

Results: The patient’s mean age was 61 years, 67% male and 42% neurocritical patients. 71% with percutaneous dilatational tracheostomy. The general mortality ratio was 17%, 6.3% in patients with stroke. There was an 8% of re-entry to the CCU. We detected a 23% of minor complications. A 43 % of the patients were decannulated during the hospital admission, 38% went home still tracheostomized but 55% of them with oral feeding. The average time at the UCC was 34 days and the average time for the hospital admission was 70 days.

Discussion: The basic aim of a safety protocol for the tracheostomized patients is to achieve an early decannulation and diminish the complications. The decannulation rate depends greatly on the reason why the tracheostomy was performed. We were able to decannulate the 66% of the patients with prolonged weaning and 26% of the patients with low level of consciousness. There is not enough evidence that this safety protocol reduces the hospital stay. 

Conclusions: This protocol has increased the efficiency of tracheostomized patients’ nursing, improving their quality of life and diminishing the mortality of the neurocritical patients. These results show that without specific strategies in areas that are not specialized, these patients’ nursing is inadequate.