Objectives: Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings.
Methods: In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit ("Go-Bags"), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda.
Results: An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures.
Conclusions: Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications.
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http://dx.doi.org/10.1177/0003489419882972 | DOI Listing |
Neurocrit Care
January 2025
Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Background: Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI.
Methods: A secondary analysis was performed on a registry of critically ill patients with ABI admitted to 73 intensive care units (ICUs) in 18 countries from 2018 to 2020.
Crit Care Med
January 2025
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Objectives: To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.
Design, Setting, And Patients: Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.
Crit Care
January 2025
Unity Health Toronto, Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.
Background: Predicting complete liberation from mechanical ventilation (MV) is still challenging. Electrical impedance tomography (EIT) offers a non-invasive measure of regional ventilation distribution and could bring additional information.
Research Question: Whether the display of regional ventilation distribution during a Spontaneous Breathing Trial (SBT) could help at predicting early and successful liberation from MV.
Med Intensiva (Engl Ed)
January 2025
Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Brazil; School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil. Electronic address:
Objective: To evaluate the feasibility of adding mechanical insufflation-exsufflation (MI-E) to a weaning protocol for tracheostomized patients undergoing prolonged mechanical ventilation (MV).
Design: Single-center, open-label, randomized, controlled pilot and feasibility study.
Setting: Intensive care unit in Brazil.
Medical device-related pressure injuries (MDRPIs) pose a significant risk in the home health environment, where patients may lack continuous professional oversight. Devices commonly used in the home environment with the potential to cause a MDRPI include but are not limited to nasogastric tubes, feeding tubes, nasal cannulas, nasal cannula prongs, airway pressure masks, indwelling urinary catheters, sequential compression devices, dressings, bandages, and tracheostomies. When a medical device is used for an extended period, it can lead to unrelieved pressure or edema, cause friction and/or shearing that impairs sensation, reduces circulation, and alters the microclimate.
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