الفهرس | Only 14 pages are availabe for public view |
Abstract Tracheostomy is among the most frequently performed procedure in critically ill patients, the benefits of tracheostomy over prolonged intubation are: reduced use of sedation, reduced trauma to the oropharynx and larynx, reduced work of breathing and improved clearance of pulmonary secretion, decreased periods of mechanical ventilation and consequently length of ICU and hospital stay. Patients, who had prolonged tracheal intubation and consequently had late tracheostomy, had more complications; airway injuries and ventilator- associated pneumonia than those who underwent early tracheostomy. The aim of this study To investigate the implementation of nursing practice for tracheostomy care of critically ill trauma patients who have tracheostomies, to provide an update on guidelines for total care to the tracheostomy. The study was conducted at the (ICU) of Assiut University Hospital. The sample of the study was in the form of convenient sample that consisted of 60 adult patients (male and female) divided equally into two groups (early and late tracheostomy). first group which tracheostomy was performed within the first 7 days of initiation of mechanical ventilation and the late tracheostomy group which tracheostomy was performed after 7 days of initiation of mechanical ventilation at any time. Our study excluded all patients with history of previous trauma but admitted to the ICU for other reasons, chronic lung disease and Readmission to the ICU and trauma referrals from other hospitals. Tools of the study Three tools designed and used by the researcher for collecting data for this study. Tool (1) physical assessments data structured interview schedule:- This tool was applied by the researcher after reviewing the related literature. It includes five parts:- Part 1:-patient’s socio-demographic data such as age and six. Part 2:- patient clinical data such as date of admission, vital signs, cause of trauma, site of trauma, mechanical ventilation data and medical diagnosis. Part 3:- Acute physiology and chronic health Evaluation score (APACHE II): Part 4:- injury severity score (ISS): Part 5:- Glasgow coma scale: Second tool: - ”tracheostomy assessment sheet” Third tool:- Evaluation sheet: - the aim of this tool was to assess the patient for the presence of signs and symptoms of infection. The main results Regarding to length of stay in ICU the current study results found that early tracheostomy patients had shorter length of stay in the ICU than late tracheostomy. As regard to patient’s condition the current study revealed that (100%) of early tracheostomy had improved while (46.7%) of late tracheostomy had improved. Regarding to discharges from trachea the current study results found that almost of the early tracheostomy had white secretion (56.7%) and almost of the late tracheostomy (86.7%) had yellowish secretion The finding of the current study related to body temperature revealed that there were highly statistical significance decreases in early tracheostomy than late tracheostomy. The results of the current study revealed that the majority of the early tracheostomy had normal breath sound (50%) at the first day, while (0.0%) of the late tracheostomy had normal breath sound at the first day, comparing with the seventh day the results revealed that (76.7%) of the early tracheostomy had normal breath sound, while (10%) of the late tracheostomy had normal breath sound at the seventh day, Regarding to timing of tracheostomy the results of the current study revealed that (16.7%)of early tracheostomy patients and(0.0%)of late tracheostomy patients had weaned from mechanical ventilation from 1to 3 days while (53.3%)of early tracheostomy patients and(6.7%)of late tracheostomy patients had weaned from mechanical ventilation from 4 to 6 days and (30%) of early tracheostomy and (93.3%) of late tracheostomy patients had weaned from mechanical ventilation in more than 7 days, while (10%)of early tracheostomy and(0.0%) of late tracheostomy patients had Decannulated from tracheostomy from 4 to 6 days, the results showed significant reduction in duration of mechanical ventilation and timing of tracheostomy. Summary - 77 - As regard to Glasgow coma score and injury severity score the results of the current study revealed that there were no significant difference between two groups in the 1st and 4th day of the study while there were high statistical significant difference between two groups in the 7th day of the study early tracheostomy show improvement in GCS than late tracheostomy, and APACHE II score the results of the current study revealed that highly statistical significant difference between two groups in all study intervals As regard to respiratory secretion culture the results of the current study revealed that (50.0%) of the early tracheostomy group had positive respiratory secretion culture at the 1st day increased to (66.7%) at the 4th day while (83.3%) of the late tracheostomy group had positive respiratory secretion culture at the 1st day increased to (90%) at the 4th day. Regarding to white blood cells the results of the current study revealed that there is highly statistical significant difference between early and late tracheostomy in all days of the study, early tracheostomy improves white blood cells. Based on the current study finding it was recommended that: Hospitals should implement protocols for tracheostomy patient on mechanical ventilation that includes each of the practices recommended by the centers for disease control and prevention. Established hand washing to prevent nosocomial respiratory tract infection. It is recommend placement and use of hand washing facilities in each unit (sink, antimicrobial soap, proper towel for draying). |