Endotracheal reintubation: a closer look at a preventable condition.

We designed a prospective study of endotracheal intubations and reintubations in our inner city Level 1 Trauma Center, to determine the frequency and causes of reintubation and evaluate the impact of an educational intervention aimed at minimizing unplanned extubations (UEs). After an initial 3-month phase, efforts were instituted to educate healthcare providers to the causes of reintubation noted. An identical 3-month period was then studied to evaluate the efficacy of the interventions. There were 862 patients, all adults, in the initial phase of the study, with 40 reintubation events in 22 patients; of the 808 in the second phase, there were 16 reintubations in 13 patients. The reintubation rate decreased from 4.4% to 1.9% (p = 0.005). Reintubations after UEs decreased from 14% to 5.2% (rate ratio, 0.374; 95% confidence interval = 0.141, 0.990). Multiple reintubation events decreased from 45% to 18.8% (p = 0.07). Increased provider education and protocol changes were associated with lower reintubation rates.

Artificial airways: a survey of cuff management practices.

OBJECTIVE: To determine current endotracheal and tracheostomy tube cuff management practices in adult and pediatric populations, and to compare current adult cuff management practice with those reported in use in 1984 and 1987. DESIGN: Descriptive survey. SETTING: Sixty-four acute care hospitals in the northeastern United States. SAMPLE: Responders represented 93 critical care units: 59 adult and 34 pediatric units. MEASUREMENTS: Subjects completed a survey questionnaire. RESULTS: Forty-one percent reported cuffs were routinely deflated, with most (88%) reporting cuff deflation every 8 to 12 hours or daily. In the pediatric population, minimal occlusive volume was the most frequent technique (29%); whereas in the adult population, both minimal occlusive volume technique and minimal leak technique were used more frequently (36%). Most (93%) cuff pressures were measured every 8 to 12 hours or daily with a recommended maximum range of 20 to 30 mm Hg. Cuff deflation and cuff inflation were performed more often by the nursing staff (36%). Cuff pressures were performed more often by respiratory staff (71%). There were no statistically significant differences in the cuff management practices between the adult and pediatric populations. In comparing the results for adults to the data of 1984 and 1987, most cuff management practices changed from every 8 hours or less to every 8 to 12 hours or daily, and the nursing responsibility for these techniques increased (22%). CONCLUSION: Most responders do not routinely deflate cuffs. Cuff management practices are performed less frequently, and nursing responsibility for these techniques has increased.

The closed tracheal suction system: implications for critical care nursing.

The Closed Tracheal Suction System (CTSS) is a multiple-use suction catheter available for suctioning the ventilator dependent patient. While research has been reported on its impact on oxygen desaturation, ventilator function, and nosocomial pneumonia, the practical issues of the technical design of the catheter and its advantage in decreasing exposure of staff to infected respiratory secretions have not been investigated. This study reports the critical care nurses' perceptions in the use of the SteriCath (Concord/Portex) CTSS focusing on hemodynamic stability, effectiveness of suctioning, patient safety and staff personnel exposure.