Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis

Author:

Moser Chandler H.1,Peeler Anna2,Long Robert3,Schoneboom Bruce4,Budhathoki Chakra5,Pelosi Paolo P.6,Brenner Michael J.7,Pandian Vinciya8

Affiliation:

1. Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

2. Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

3. Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland.

4. Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland.

5. Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University.

6. Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy.

7. Michael J. Brenner is an associate professor, Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina.

8. Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University.

Abstract

Background In the critical care environment, individuals who undergo tracheostomy are highly susceptible to tracheostomy-related pressure injuries. Objective To evaluate the effectiveness of interventions to reduce tracheostomy-related pressure injury in the critical care setting. Methods MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units conducted to evaluate interventions to reduce tracheostomy-related pressure injury. Reviewers independently extracted data on study and patient characteristics, incidence of tracheostomy-related pressure injury, characteristics of the interventions, and outcomes. Study quality was assessed using the Cochrane Collaboration’s risk-of-bias criteria. Results Ten studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria. The incidence of tracheostomy-related pressure injury was 17.0% before intervention and 3.5% after intervention, a 79% decrease. Pressure injury most commonly involved skin in the peristomal area and under tracheostomy ties and flanges. Interventions to mitigate risk of tracheostomy-related pressure injury included modifications to tracheostomy flange securement with foam collars, hydrophilic dressings, and extended-length tracheostomy tubes. Interventions were often investigated as part of care bundles, and there was limited standardization of interventions between studies. Meta-analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy-related pressure injury. Conclusions Use of hydrophilic dressings and foam collars decreases the incidence of tracheostomy-related pressure injury in critically ill patients. Evidence regarding individual interventions is limited by lack of sensitive measurement tools and by use of bundled interventions. Further research is necessary to delineate optimal interventions for preventing tracheostomy-related pressure injury.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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