Comprehensive tracheostomy care: from ICU to the general ward

Abstract

Tracheostomy has been used historically to treat airway obstruction. However, since the polio epidemic in the middle of the 20th century, tracheostomy became established as the treatment of choice for long-term airway management during positive pressure ventilation. Tracheostomized patients can be managed in intensive care units, general wards, and at home because of improved survival rates of critically ill patients. Therefore, a comprehensive tracheostomy management strategy that takes into consideration the long-term quality of life of the patients is required. Safety management protocols, including prevention of obstruction and displacement of the tracheal cannula, have not yet been standardized, particularly in general wards, and it is an urgent issue that requires to be immediately addressed. Although successful removal of a tracheal cannula is a time-consuming process, no standard algorithm for decannulation has been established, and it is rarely performed following transfer from acute care hospitals in Japan. It is suggested that patients with a tracheostomy cannula in place have poor outcomes; therefore, establishing a strategy for tracheal cannula removal and promoting safety measures by establishing a multidisciplinary tracheostomy team may improve the patient outcomes and reduce the associated healthcare costs. Overseas, there have been advanced efforts in this field; thus, development of an action plan for long-term systematic management of patients undergoing tracheostomy in Japan is strongly desired.