It is known that the incidence of aspiration is high in patients with tracheostomy. However, it is unclear which patient population with tracheostomy has a higher chance to aspirate. This study aims to determine the predictors of swallowing outcome of patients with tracheostomy. Eighty- three patients with tracheostomies who underwent videofloroscopy for swallowing were recruited in the study. Analysis was done on the presence of aspiration as well as the feeding status with respect to medical conditions and duration of tracheostomy. The prevalence of aspiration and silent aspiration were found to be high in patients with tracheostomy. The incidence of tube feeding was also found to be high in this patient population. Vocal cord paralysis was found to be a significant predictor of aspiration and silent aspiration in patients with tracheostomy. Head and neck cancer and vocal cord paralysis were found to be associated with tube feeding in patients with tracheostomy. / published_or_final_version / Surgery / Master / Master of Medical Sciences

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1991. / Vita. Abstract. Includes bibliographical references (leaves 84-90). Also available via the Internet.

Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 55-57).

Thesis (M.S.)--University of Wisconsin--Madison, 1982. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 44-47).

Thesis (M.S.)--University of Wisconsin--Madison, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 89-92).

Thesis (M.S.)--University of Wisconsin--Madison, 1983. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 67-70).

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23064号 / 医博第4691号 / 新制||医||1048(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 伊達 洋至, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: Although a tracheostomy is a common procedure for patients who require prolonged mechanical ventilation, little evidence exists as to the best practices for performing tracheostomy care to maintain the airway and promote skin integrity. Therefore, variability is likely, which may negatively impact patient outcomes. This study described tracheostomy care practices of registered nurses (RNs) and respiratory therapists (RTs) who regularly perform tracheostomy care in critical care settings. Methodology: The descriptive study was conducted following informed consent. RNs (n=15) and RTs (n=5) were asked to perform tracheostomy care on a simulated mannequin patient. An array of supplies (both required and not necessary) was available to perform tracheostomy care. The procedure was video-recorded and the researchers also used an observation checklist. Equipment used and steps performed were compared to hospital policy and the American Association of Critical-Care Nurses (AACN) Procedure Manual. Data were analyzed with descriptive statistics. Results: The majority (80%) of participants were female and held a baccalaureate degree; median experience was 5 years. Equipment selection varied widely; supplies used by 50% or more of participants included non-sterile gloves, hydrogen peroxide, cotton swabs, disposable cannula, foam ties, and gauze dressings. The order of steps was variable with unique differences noted among all participants. The most common sequence was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing. No one performed in the order recommended in the AACN Procedure Manual. Wide variability in practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care. Discussion: Research supported the belief that variation to technique and supplies does exist when performing tracheostomy care. Tracheostomy varied from provider to provider within one hospital unit, demonstrating the need for further research and protocols for tracheostomy care. Education on existing protocols and evidence-based practice should be conducted to ensure that providers are following unit protocols.

A traqueostomia percutânea é um procedimento realizado rotineiramente na Unidade de Terapia Intensiva (UTI), guiada por broncoscopia. Recentemente, a ultrassonografia tem surgido como uma ferramenta potencialmente útil para assistir à traqueostomia percutânea e reduzir as complicações relacionadas ao procedimento. Um ensaio clínico randomizado, aberto, paralelo, de não inferioridade, foi conduzido comparando a traqueostomia percutânea guiada por ultrassonografia com a traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI. O desfecho primário, a falência do procedimento, foi definido como um desfecho composto, incluindo (1) a conversão para traqueostomia cirúrgica, (2) o uso associado e não planejado da broncoscopia ou da ultrassonografia, ou (3) a ocorrência de uma complicação maior. Um total de 4.965 pacientes foram avaliados quanto a elegibilidade. Desses, 171 pacientes foram elegíveis e 118 foram submetidos ao procedimento, com 60 pacientes randomizados para o grupo ultrassonografia e 58 pacientes randomizados para o grupo broncoscopia. A falência do procedimento ocorreu em um (1,7%) paciente no grupo ultrassonografia e um (1,7%) paciente no grupo broncoscopia, sem diferença no risco absoluto entre os grupos (intervalo de confiança de 90%, -5,57 a 5,85), na análise \"conforme tratados\", não incluindo a margem de não inferioridade pré-especificada de 6%. Nenhum outro paciente apresentou uma complicação maior em ambos os grupos. As complicações menores relacionadas ao procedimento ocorreram em 20 (33,3%) pacientes no grupo ultrassonografia e em 12 (20,7%) pacientes no grupo broncoscopia, (P = 0,122). A duração do procedimento foi de 11 [7-19] vs. 13 [8-20] minutos (P = 0,468), respectivamente, e os desfechos clínicos também não foram diferentes entre os grupos. Em conclusão, a traqueostomia percutânea guiada por ultrassonografia é eficiente, segura e associada com taxas de complicações semelhantes à traqueostomia percutânea guiada por broncoscopia, em pacientes sob ventilação mecânica na UTI / Percutaneous Dilational Tracheostomy (PDT) is routinely performed in the intensive care unit (ICU) with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool in order to assist PDT and reduce procedure-related complications. An open-label, parallel, non-inferiority, randomized controlled trial was conducted comparing the ultrasound-guided PDT with the bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy; unplanned associated use of bronchoscopy or ultrasound during PDT; or the occurrence of a major complication. A total of 4,965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7%) patient in the ultrasound group and one (1.7%) patient in the bronchoscopy group, with no absolute risk difference between the groups (90% confidence interval, -5.57 to 5.85), in the \'as treated\' analysis, not including the pre-specified margin of 6% for noninferiority. No other patient had any major complication in both of the groups. Procedure-related minor complications occurred in 20 (33.3%) patients in the ultrasound group and in 12 (20.7%) patients in the bronchoscopy group, (P=0.122). The median procedure length was 11 [7-19] vs. 13 [8-20] minutes (P=0.468), respectively, and the clinical outcomes were also not different between the groups. In conclusion, ultrasound-guided PDT is effective, safe and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided tracheostomy in mechanically ventilated critically ill patients

Thesis (M.S.)--University of Wisconsin--Madison, 1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 77-82).