Newman, Helen Mary;
(2024)
Choosing the right tracheostomy tube for adults in intensive care: size matters.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
INTRODUCTION: Tracheostomy tubes (TTs) are artificial airways commonly used in ICU. The size of TT is important. Inner and outer diameters should be balanced to allow breathing both through and around the TT. Undersizing can cause difficulties in delivering mechanical ventilation. Oversizing can prevent patients speaking and risks tracheal trauma. There are no clear guidelines on choosing size of TT for adults in ICU. AIM: To develop evidence-based guidance on factors to consider when selecting the size of TT for adults in ICU. Secondary aim: to identify barriers and facilitators to changing practice. METHODS: This mixed methods project used qualitative evidence synthesis; an observational study of theoretical sizing outcomes using current methods; a benchtop investigation of the effect of size of TT on work of breathing; and focus groups of ICU clinicians to generate knowledge on a range of factors involved in TT size decision-making. RESULTS: The key findings were that current sizing practices are not patient-centred and are likely to result in poor fit of TTs within the trachea, more so in females. The impact of TT size on function depends on tracheal size and respiratory parameters. Decision-makers underestimate problems caused by sizing decisions and the importance to patients of voice. Gaps in the evidence are a major barrier to improvement. Joint MDT learning and redesign of TTs could facilitate change and improve patient outcomes. CONCLUSIONS: Good practice should tailor decisions to the individual. Size should be based on anatomical and physiological parameters and aim to allow one-way valve use to restore laryngeal functions, particularly voice. The wider MDT should be involved in sizing decisions and policy to ensure holistic care for patients. Re-design of TTs may make decisions easier for clinicians and help achieve humanisation of care for patients.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Choosing the right tracheostomy tube for adults in intensive care: size matters |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | Tracheostomy, intensive care, critical care, patient-centred care, multidisciplinary team |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10196965 |
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