dc.contributor.author | Pryor, Lee | |
dc.contributor.author | Ward, Elizabeth | |
dc.contributor.author | Cornwell, Petrea | |
dc.contributor.author | O'Connor, Stephanie | |
dc.contributor.author | Chapman, Marianne | |
dc.date.accessioned | 2018-07-30T01:30:36Z | |
dc.date.available | 2018-07-30T01:30:36Z | |
dc.date.issued | 2016 | |
dc.identifier.issn | 1368-2822 | |
dc.identifier.doi | 10.1111/1460-6984.12231 | |
dc.identifier.uri | http://hdl.handle.net/10072/142699 | |
dc.description.abstract | Background: Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about
patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the
clinical population and/or reason for tracheostomy insertion.
Aims: To document patterns of clinical management around the commencement of oral intake throughout hospital
admission and along the decannulation pathway in patients with a new tracheostomy, and to examine the nature
of variability across multiple clinical populations.
Methods & Procedures: A 12-month retrospective review of 126 patients who had undergone an acute tracheostomy
was conducted. Within the cohort, patients were further classified into eight clinical populations representing
specialty areas within the tertiary referral centre. Data were collected on timing of milestones and patterns of
clinical management related to oral and enteral feeding and decannulation. Relationships between temporal
variables were calculated, in addition to descriptive analysis of the overall cohort and by clinical population.
Outcomes & Results: Median temporal markers of patient progression post-tracheostomy insertion for the cohort
were: continuous cuff deflation after 7.5 days, commencement of oral intake after 10.5 days, decannulation
after 15 days and cessation of enteral nutrition (EN) after 17 days. However, considerable individual variation
and differences between clinical populations was observed. Overall, 86% of the cohort returned to oral intake,
although 25% were discharged with EN via a gastrostomy. A total of 86% of the group were decannulated by
hospital discharge. Oral intake was introduced at every stage of the decannulation pathway, including prior to
cuff deflation, but the majority of patients commenced diet/fluids following cuff deflation or with an uncuffed
tube in situ, and most patients who ceased EN did so following decannulation. Commencement of oral intake
was evenly split between the intensive care unit (ICU) and the wards. Increased time to commencement of oral
intake correlated with increased time to decannulation (r = .805, p = .001), and increased time to decannulation
correlated with increased hospital length of stay (r = .687, p = .006). Whilst cohort patterns were observed within
the heterogeneous group, sub-analysis revealed distinct patterns of oral intake management across the different
clinical populations.
Conclusions & Implications: The data provide benchmarks enabling comparison by overall cohort as well as by
specialist clinical populations, each with differing reasons for tracheostomy insertion. The data would suggest that
tracheostomy patients should not be looked upon as a singular cohort; rather, evaluation of factors with specific
attention made to underlying aetiology and individual clinical presentation is essential. | |
dc.description.peerreviewed | Yes | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | Wiley Online | |
dc.relation.ispartofpagefrom | 556 | |
dc.relation.ispartofpageto | 567 | |
dc.relation.ispartofissue | 5 | |
dc.relation.ispartofjournal | International Journal of Language and Communication Disorders | |
dc.relation.ispartofvolume | 51 | |
dc.subject.fieldofresearch | Clinical sciences | |
dc.subject.fieldofresearch | Cognitive and computational psychology | |
dc.subject.fieldofresearch | Cognition | |
dc.subject.fieldofresearch | Linguistics | |
dc.subject.fieldofresearchcode | 3202 | |
dc.subject.fieldofresearchcode | 5204 | |
dc.subject.fieldofresearchcode | 520401 | |
dc.subject.fieldofresearchcode | 4704 | |
dc.title | Patterns of return to oral intake and decannulation post-tracheostomy across clinical populations in an acute inpatient setting | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Cornwell, Petrea | |