Establishment of an evidence-based protocol for tracheotomy care in adult patients

doi:10.19439/j.sjos.2017.05.015

Abstract

Abstract: PURPOSE: To establish a clinical practice protocol for tracheotomy care of adult patients. METHODS: Though constructive document retrieval, personnel interview and brain-storming, protocol draft was constructed. Delphi method was used in the study, and the final protocol was based on two rounds of consultation among 15 experts from 10 tertiary general hospitals. SPSS 16.0 software package was used for statistical analysis. RESULTS: The effective rates of two rounds of questionnaire were 100% and 93.3%, the authority coefficient was 0.83, and the P value of expert coordination coefficients W was less than 0.05. The final evidence-based protocol for tracheotomy care in adult patients consists of 5 sections, 16 dimensions and 61 items. CONCLUSIONS: The evidence-based tracheotomy care protocol was combined with Chinese clinical status and experts' opinion. The protocol was scientific and credible, which may play an important role in clinical practice.

Key words: Tracheotomy, Nursing, Delphi method, Plan constructed

CLC Number:

R473

WANG Hui-fen, YU Lei-lei, RUAN Hong, HU Jia-le, YUAN Wei-jun, JIANG Li-li, HAO Gui-hua. Establishment of an evidence-based protocol for tracheotomy care in adult patients[J]. Shanghai Journal of Stomatology, 2017, 26(5): 539-544.

References

[1] 尤荣开. 人工气道建立与维护[M]. 北京: 人民军医出版社, 2002: 130.
[2] 李清明, 彭培宏. 气管切开手术适应证的变化和发展 [J]. 临床耳鼻咽喉科杂志, 2004, 18(3): 171-172.
[3] 中华人民共和国卫生部,中国人民解放军总后勤部卫生部. 临床护理实践指南（2011版）[EB/OL]. http://www.moh.gov.cn/publicfiles//business/htmlfiles/wsb/index.htm.
[4] 上海市卫生局, 中华医学会上海分会. 护理常规 [M]. 上海: 上海科学技术出版社, 1999.
[5] 上海市护理质控中心. 护理技术操作考核要点[S]. 2007.
[6] 戴宝珍, 余剑珍. 临床护理教程 [M]. 上海: 复旦大学出版社, 2004.
[7] 姜安丽. 新编护理学基础 [M]. 北京: 人民卫生出版社, 2006.
[8] The Joanna Briggs Institute. Evidence Based Nursing and Midwifery. Tracheal suctioning of adults with an artificial airway (2000)[EB/OL]. Connect.jbiconnectplus.org/ViewSourceFile. Asps?0=4315.
[9] American Association for Respiratory Care. AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010 [J]. Respir Care, 2010, 55(6): 758-764.
[10] Jayasekara R. Artificial airway: suctioning[J]. JBI Database System Rev Implement Rep, 2012, 10(1): 1-6.
[11] Hess DR, Kallstrom TJ, Mottram CD, et al. Care of the ventilator circuit and its relation to ventilator-associated pneumonia [J]. Respir Care, 2003, 48(9): 869-879.
[12] AARC, Respiratory Home Care Focus Group. AARC clinical practice guideline. Long-term invasive mechanical ventilation in the home-2007 revision & update [J]. Respir Care, 2007, 52(8): 1056-1062.
[13] Muscedere J, Dodek P, Keenan S, et al. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention[J]. J Crit Care, 2008, 23(1): 126-137.
[14] Manager A, Douglas HS. Guideline for humidification of oxygen for adult self ventilating and temporary tracheostomy patients [Z]. 2013.
[15] Masterton RG, Galloway A, French G, et al. Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy[J]. J Antimicrob Chemother, 2008, 62(1): 5-34.
[16] Institute for Clinical Systems Improvement. Health care protocol: prevention of ventilator-associated pneumonia. Bloomington[EB/OL]. (2011-11)[2016-02-02]. https://www.icsi.org/_asset/y24ruh/VAP.pdf.
[17] American Association for Respiratory Care, Restrepo RD, Walsh BK. Humidification during invasive and noninvasive mechanical ventilation: 2012 [J]. Respir Care, 2012, 57(5): 782-788.
[18] Intensive Care Society. Standards for the care of adult patients with a temporary tracheostomy-standards and guidelines (2014) [EB/OL]. [2014-06-12]. https://www.evidence.nhs.uk/Search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy standards+and+guidelines.
[19] Watson MG, Ryles SJ, Quraishi MS. Tracheostomy adult care policy (2014) [EB/OL]. http://www.dbh.nhs.uk/Library/Patient_Policies/PAT%20T%2020%20v%205%20-%20Tracheostomy%20Adult%20Care%20Policy%20-%20final.pdf.
[20] Evans JM, Kiran PR, Bhattacharyya OK. Activating the knowledge-to-action cycle for geriatric care in India [J]. Health Res Policy Syst, 2011, 9: 42.
[21] 董玉静, 李葆华, 侯淑肖. 应用德尔菲法建立脑卒中患者延续性护理方案 [J]. 中国护理管理, 2013, 13(10): 34-37.
[22] Powell C. The Delphi technique: myths and realities [J]. J Adv Nurs, 2003, 41(4): 376-382.
[23] 程琮, 刘一志, 王如德. Kendall 协调系数 W 检验及其 SPSS 实现 [J]. 泰山医学院学报, 2010, 31(7): 487-490.
[24] Dawson D. Essential principles: tracheostomy care in the adult patient [J]. Nurse Critical Care, 2014, 19(2): 63-72.
[25] Morris LL, Whitmer A, Mcintosh E. Tracheostomy care and complications in the intensive care unit [J]. Crit Care Nurse, 2013, 33(5): 18-30.
[26] 蒋红, 高秋韵, 顾妙娟. 临床护理技术操作规范[M]. 第2版. 上海: 复旦大学出版社, 2012.
and other autoimmune and inflammatory disorders[J]. Bio Drugs, 2013, 27(5):439-452.
[22] 王栋, 李言君, 付爱丽, 等. Treg与IL-17在复发性口腔溃疡中表达的相关性研究 [J]. 实用口腔医学杂志, 2012, 28(4): 466-469.
[23] 林佳如, 樊均明. 白细胞介素17在IgA肾病中引起IgA1糖基化异常的作用研究 [J]. 重庆医学, 2016, 45(28): 3907-3909.
[24] 刘瑜, 赵宏霞, 曹敏, 等. 哮喘患儿血清白细胞介素-4、白细胞介素-17和干扰素-γ水平的检测 [J]. 中国实验诊断学, 2013, 17(4): 735-737.
[25] Pan HF, Ye DQ, Li XP. Type 17 T-helper cells might be a promising therapeutic target for systemic lupus erythematosus [J]. Nat Clin Pract Rheumatol, 2008, 4(7): 352-353.
[26] Garrett-Sinha LA, John S, Geffen SL. IL-17 and the Thl7 lineage in systemic lupus erythematosus[J]. Curr Opin Rheumatol, 2008, 20(5): 519-525.
[27] Maddur MS, Vani J, Hegde P, et al. Inhibition of differentiation, amplification, and function of human TH17 cells by intravenous immunoglobulin [J]. J Allergy Clin Immunol, 2011, 127(3): 823-830.