Tracheotomy Closure Protocol in a Rehabilitation Institution

• Autor(a) principal: Cunha, Maria; Interna de Formação Específica de Medicina Física e de Reabilitação, CMRRC-RP, Tocha Portugal
• Data de Publicação: 2013
• Outros Autores: Barbosa, João; Interno de Formação Específica de Otorrinolaringologia, CHUC, Coimbra, Portugal, Margalho, Paulo; Assistente Hospitalar Graduado de MFR, CMRRC-RP, Tocha Portugal, Tomé, Pedro; Assistente Hospitalar Graduado de Otorrinolaringologia, CHUC, Coimbra, Portugal, Laíns, Jorge; Assistente Hospitalar Graduado de MFR, CMRRC-RP, Tocha Portugal
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25759/spmfr.10

Purpose: Tracheotomy is a temporary or permanent procedure for treatment of upper respiratory tract failure, neurologic pathology, and trauma. It also presents some disadvantages: cervical dysmorphia, need for cannula cleaning/replacement, oral communication difficulties, absence of nasal function and tracheomalacia risk. Accordingly, as soon as possible, tracheotomy closure is needed in patient ́s rehabilitation. Cannula removal should only be considered if upper airway obstruction has solved, respiratory secretions are minimal and there is no need for mechanical ventilation. Predictors of success: ability to produce cough and absence of aspiration phenomena. Cannula withdrawal requires care, particularly after prolonged use. A standardized protocol optimizes performance and minimizes risks. PMR, in partnership with other specialties and health professionals, has a key role to play in this procedure. We present the protocol used in tracheotomy closure in our PMR institution. Material and methods: Literature search about tracheotomy management and closure protocols Results: Protocol (steps to follow-resume): - Deflate the cuff - Change to an uncuffed tracheostomy tube with smaller diameter - Partial cannula closure - Complete tube closure - Cannula removal and stoma closure Important remarks: - Set responsible physician - Evaluate the need of protocol adaptation with nursing team - Inform the patient and collect consent - Teach patient/caregivers how to act in case of sudden dyspnea - Monitor O2 saturation/patient surveillance - Each step must last a minimum of 12 hours. Conclusions: The PMR team skills and knowledge are essential in the tracheotomy closure comprehensive approach. A protocol improves its management. Scientific information is scarce and valid studies are needed in this field. PMR should contribute to improve the services provided to these patients. Keywords: Tracheotomy/rehabilitation; Airway Management.