A plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient’s ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications.
Features| February 01 2014
The Importance of Tracheostomy Progression in the Intensive Care Unit
Linda L. Morris, PhD, APN, CCNS;
Linda L. Morris is a clinical nurse specialist in respiratory care at Northwestern Memorial Hospital, Chicago, Illinois, and an associate professor of clinical anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. She is also a member of the board of directors for the Global Tracheostomy Collaborative, an international group of specialists dedicated to research and quality outcomes for patients with tracheostomies.
Corresponding author: Linda L. Morris, phd, apn, ccns, fccm, Northwestern Memorial Hospital, 251 E. Huron Street, Feinberg Pavilion, Suite 8-330, Chicago, IL 60611 (e-mail: firstname.lastname@example.org).
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Erik McIntosh, RN, MSN, ACNP-BC;
Crit Care Nurse (2014) 34 (1): 40–48.
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Linda L. Morris, Erik McIntosh, Andrea Whitmer; The Importance of Tracheostomy Progression in the Intensive Care Unit. Crit Care Nurse 1 February 2014; 34 (1): 40–48. doi: https://doi.org/10.4037/ccn2014722
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