HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Research Original Investigation

Standardized Tracheostomy Care and Life-Threatening Respiratory Events

underscoring that effective reduction of rapid responses can reduce overall stays in ICUs. Building on the framework of this study, future studies are planned to perform root cause analysis of other causes for rapid responses and poten- tially develop additional protocols to address these signifi- cant events.

occurrence of acute rapid-response calls due to respiratory compromise. Successful implementation required not only generation of a standardized protocol, but also continued sur- veillance of the various units and their compliance. In addition, the time spent in ICUs were increased in a clinically meaningful way with rapid-response calls in both groups,

ARTICLE INFORMATION Accepted for Publication: March 15, 2018. Correction: This article was corrected on June 21, 2018, for errors in the description of suction required by patients in the Box. Published Online: May 24, 2018. doi: 10.1001/jamaoto.2018.0484 Author Contributions: Dr Hackman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Masood, Hackman. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Masood, Biancaniello, Hackman. Critical revision of the manuscript for important intellectual content: Masood, Farquhar, Hackman. Statistical analysis: Masood, Farquhar. Administrative, technical, or material support: Masood, Biancaniello, Hackman. Study supervision: Farquhar, Hackman. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. decannulation. Respir Care . 2010;55(8):1076-1081 . 2 . Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care . 2014;59(6):895-915 . 3 . Rowe BH, Rampton J, Bota GW. Life-threatening luminal obstruction due to mucous plugging in chronic tracheostomies: three case reports and a review of the literature. J Emerg Med . 1996;14(5): 565-567 . 4 . Fahy JV, Dickey BF. Airway mucus function and dysfunction. N Engl J Med . 2010;363(23):2233-2247 . 5 . Cosgrove JF, Carrie S. Indications for and management of tracheostomies. Surgery (Oxford) . 2015;33(4):172-179. 6 . Buglass E. Tracheostomy care: tracheal suctioning and humidification. Br J Nurs . 1999;8(8): 500-504 . 7 . Mark LJ, Herzer KR, Cover R, et al. Difficult airway response team: a novel quality improvement program for managing hospital-wide airway emergencies. Anesth Analg . 2015;121(1):127-139 . 8 . Tirkkonen J, Tamminen T, Skrifvars MB. Outcome of adult patients attended by rapid REFERENCES 1 . O’Connor HH, White AC. Tracheostomy

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JAMA Otolaryngology–Head & Neck Surgery June 2018 Volume 144, Number 6 (Reprinted)

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