HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Otolaryngology–Head and Neck Surgery 156(4)

Table 2. Comparison of Patient Characteristics by TRAPU Status.

No TRAPU

TRAPU

n

%

n

%

P Value

59.02 a 22.35 a 18.24 a

57.91 a 28.59 a 21.36 a

.742

Age, y

.033 b

Length of stay, d

Days in intensive care unit

.235 .505

Sex

Female

135 181

43 57

11 11

50 50

Male

Race/ethnicity

.532

Black

125

44 14 42

10

50 20 30

Hispanic

41

4 6

White

121

Charlson/Deyo score

.25

0 1 2 3 4

24 52 48 57 40 95

8

1 2 4 7 5 3 5 8 9 6 0 9 1 5 4 6 3 4 0

5 9

16 15 18 13 30 11 38 50 22

18 32 23 14 23 36 41 27

5

Service

.277

Cardiothoracic Otolaryngology General surgery

36

121 159

Congestive heart failure Peripheral vascular disease Cerebrovascular disease

71 17

.603 .264 .914 .218 .431 .473 .479 .277 .864

5

0

133

42

41

Dementia

4

1

5

Chronic obstructive pulmonary disease

97 79 66 75 53

31 25 21 24 17

23 18 27 14 18

Diabetes

Hemiplegia/paraplegia

Renal disease

Cancer

Moderate/severe liver disease

8

3

0

.45

Abbreviation: TRAPU, tracheostomy-related acquired pressure ulcer. a Mean. b P \ .05.

The initial exchange of a percutaneous-placed tracheostomy tube usually occurs between 10 and 14 days after tube place- ment. This timeline for initial tube exchange was also supported in the same consensus statement. 10 This recommendation allowed for a longer maturation period for percutaneous dilata- tional tracheotomies. In this setting, one would need to consider either a longer period of suture retention or removal of sutures prior to the initial tube change. During the initial audit period, we noted that 2 patients had their tracheostomy sutures in place for . 7 days, but neither of these patients developed a TRAPU. The choice of dressing materials for use in the study pro- tocol was based on the limited previously published experi- ence found in the medical literature. Use of an adhesive and occlusive dressing was previously suggested and subse- quently prospectively studied with a noted subjective improvement in the amount of skin maceration and injury

Table 3. Tracheostomy-Related Acquired Pressure Ulcer Staging.

Stage I Stage II Stage III Stage IV Unstageable Total

Preintervention 0 Postintervention 0

5 0

9 0

0 0

6 2

20

2

Consensus regarding whether tracheostomy sutures should be used for adult patients following tracheostomy was not reached. 10 The statement, however, does support removal of tra- cheostomy sutures within 7 days after an open tracheostomy. This particular study intervention may require some adapta- tion if it is to be applied in a setting where percutaneous dilata- tional tracheostomy is performed and plate sutures are placed.

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