Importance of Performing Early Tracheotomies
Literature Review
Introduction
The literature review will compare two studies covering the nursing issues about the importance of performing early tracheostomies in patients with severe burns in order to reduce the rate of ICU delirium, pneumonia, and also reduce the length of stay with the intensive care unit (ICU). Tracheostomy is done to improve airflow, ensure safe delivery of oxygen to the lungs, and remove airway secretions (Mourelo et al., 2015). Severely burned patients often sustain damaged respiratory system and inhalation injury; this causes airway obstruction, respiratory failure, and respiratory arrest indicating the importance of performing early tracheostomies. Importance of Performing Early Tracheotomies
Compare and Contrast
Mourelo et al (2015) performed a retrospective study on adult patients who had a tracheostomy in the target hospital. The aim of the study was to evaluate the clinical impact of tracheostomy among patients with burns. An ethical approval was sought from the ethics committee before the study started. Data was collected for all patients admitted in the Burns Ward between 1995 and 2013 and underwent tracheostomies. These study subjects were compared with the control group that included burn patients admitted in the same Burn Unit during the same period but did not undergo tracheostomy. SPSS software was used to perform data analysis. A descriptive analysis was conducted and continuous variables described as median, mean ± standard deviation, and range. Frequencies and percentages were calculated for the qualitative variables.
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The findings of Mourelo et al (2015) indicated that tracheostomy is a safe procedure in patients with burns and does not increase rate of respiratory infection or mortality. However, the findings of this study indicated that tracheostomy increased morbidity rate and patients who underwent tracheostomies required longer period of mechanical ventilation and had a longer hospital stay.
Li et al (2020) performed a retrospective review study on pediatric patients with severe burns and underwent tracheostomy between 2004 to 2019. The aim of the study was to determine the characteristics of pediatric patients with severe burns and underwent tracheostomy and establish the risk factors allied to tracheostomies complications. Collected data included the demographics such as gender and age and data about total burn surface area, inhalation injury, burn mechanisms, indication for tracheostomy, duration of ventilation, tracheostomy duration, and complications allied to tracheostomy. SPSS was to perform data analysis. Importance of Performing Early Tracheotomies
According to the study findings, children with severe burns were susceptible to the obstruction of the upper airway and hence establishing safe and effective airway is vital for this patient population. The findings showed that early tracheostomy in patients with severe burns is effective and safe as it provides a stable airway, in addition to improving mechanical ventilation management. Additionally, tracheostomy as associated with low incidence of pneumonia. However, findings from Mourelo et al (2015) indicated that tracheostomy is associated with increased morbidity while Li et al (2020) demonstrated that tracheostomy in patients with severe burns reduces morbidity and infections such as pneumonia.
Conclusion
The findings from both studies indicate that that tracheostomy is a safe procedure in patients with burns and does not increase rate of mortality. The findings also indicate that early tracheostomy stabilizes the airway in patients with severe burns. Effective airway control is vital for patients with severe burns as it stabilizes the airway, improve mechanical ventilation, and reduces the rate of respiratory infections such as pneumonia.
References
Li, X., Chen, B., Kuang, F., Zhang, Z., Chen, L., Liu, Z., … & Feng, Q. (2020). Early tracheostomy in severely burned pediatric patients: 16-year experience at a tertiary burn center in China. DOI: 10.21203/rs.3.rs-17396/v1
Mourelo, M., Galeiras, R., Pértega, S., Freire, D., López, E., Broullón, J., & Campos, E. (2015). Tracheostomy in the management of patients with thermal injuries. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(8), 449–455. https://doi.org/10.4103/0972-5229.162460 Importance of Performing Early Tracheotomies