Characteristics of Interdisciplinary approach in early versus late tracheostomy patients

Josefina Bunster, Sylvana Aedo, Hans Baez
Purpose:

This study aims to determine the difference in rehabilitation times between patients with early and late TQT. 

Methods:

A retrospective observational study. 86 patients admitted to the ICU of the Hospital del Trabajador who required a TQT were included. Two patients who were admitted with TQT and 18 patients who were transferred to another care center with TQT installed were excluded. Patients who died with TQT installed (n=8) were excluded from the final analysis. The information was collected from the internal database of the Hospital. The data was analyzed according to 4 groups of variables: personal and clinical outcomes; characteristics of the TQT; outcomes related to motor and swallowing rehabilitation; and outcomes related to decannulation process. 

Results:

56 patients were included in the final analysis. The average age was 52±12 years, and the majority were men (73%). The most frequent diagnosis was COVID (57%), followed by Traumatic Brain Injury (21.4%). The median TQT time was 18[14-24] days for the total population, 68% of TQTs were late performed, IMV time (20.5[16-24] versus 31.5[22 -46]; p0.05) and length of ICU stay (23[20-29] versus 41[26.5-52]; p0.05), was lower in early TQT compared to late TQT. The time in which patients achieve higher functional positions was shorter in the early TQT compared to late TQT (Sat on edge of bed: 18[16-24] versus 32[21-36], p0.05; Bipedal: 26.5[18-39] versus 42[31-62], p0.05; Walk: 34.5[21-40] versus 59[37-73], p0.05). Similarly, occurred with swallowing variables, the intake times were shorter in the early TQT compared to late TQT, (intake commencement: 32 [25-45] versus 46.5 [36-59], p0.05; Complete oral intake:  41 [33-47] versus 58 [48-75], p0.05).

Conclusion(s):

Early TQT is beneficial to reduce the IMV days and length of ICU stay, in addition, it allows early motor and swallowing rehabilitation. 

Implications:

This study provides information on the benefits of performing an early tracheostomy with interdisciplinary rehabilitation, demonstrating that coordinated interdisciplinary management allows optimal rehabilitation times for TQT patients.

Funding acknowledgements:
This study has no associated funding.
Keywords:
Interdisciplinary rehabilitation
Tracheostomy
Early rehabilitation
Primary topic:
Disability and rehabilitation
Second topic:
Critical care
Third topic:
Cardiorespiratory
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Comité ético científico Hospital del Trabajador
Provide the ethics approval number:
2022/15/CEC
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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