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Volume 3 Supplement 1

ESICM LIVES 2015

  • Poster presentation
  • Open Access

National survey of intensive care trainees' experience of and training in tracheostomy and laryngectomy management

  • 1,
  • 2,
  • 2 and
  • 1
Intensive Care Medicine Experimental20153 (Suppl 1) :A678

https://doi.org/10.1186/2197-425X-3-S1-A678

  • Published:

Keywords

  • Airway Management
  • Critical Care Unit
  • Theatre List
  • Intensive Care Society
  • Airway Emergency

Introduction

Recent studies in the United Kingdom [1],[2] have highlighted serious shortfalls in the care of patients with a tracheostomy or laryngectomy. Such patients potentially require time-critical, decisive airway management, likely involving resident intensive care clinicians. However, previous regional studies identified critical care trainees as inadequately trained and experienced to confidently manage airway emergencies in neck breathers [3].

Objectives

We surveyed Scottish intensive care trainees to ascertain whether such deficits are widespread and persistent.

Methods

Trainees were invited to complete a web-based questionnaire on three occasions in June 2014. Responses in the form of ticked boxes or free text were collated and analysed for trends.

Results

Ninety-nine trainees replied, of whom 96 were based in anaesthesia, one in emergency medicine and two in allied medical specialties. Alarmingly, 70 respondents (71%) had been involved in managing an airway emergency in a patient with a tracheostomy or laryngectomy, 63 (90%) on a critical care unit and 40 (57%) on a general ward. Deficits in staff training and equipment were identified as contributory by 28 (40%) and 10 (14%) respondents, respectively. Most trainees (68%) felt quite confident in caring for neck breathers, with confidence increasing as training progressed. However, the majority of trainees accrued such confidence through exposure to these patients on theatre lists (80%). Only a minority had participated in simulated emergencies (33%) or a formal training course (14%). Almost half (49%) rated their training as deficient or absent and the vast majority (96%) felt there was a place for more formal tuition in caring for patients with a tracheostomy or laryngectomy.

Conclusions

Our findings suggest that we are failing to prepare trainees for the challenges of managing airway emergencies in neck breathers. Divergence of anaesthesia and intensive care training in the UK may further compound this problem by reducing exposure to controlled subglottic airway management in theatre. The Scottish Intensive Care Society Trainee Committee has sought to address these deficits in training and reduce the burden of avoidable harm by incorporating sessions on tracheostomy management into its educational programme.

Authors’ Affiliations

(1)
Victoria Infirmary, Glasgow, United Kingdom
(2)
Royal Infirmary, Edinburgh, United Kingdom

References

  1. Cook TM, Woodall N, Harper J, et al: Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. British Journal of Anaesthesia. 2011, 106: 632-42. 10.1093/bja/aer059.PubMedView ArticleGoogle Scholar
  2. National Confidential Enquiry into Patient Outcome and Death. On the Right Trach? A review of the care received by patients who underwent a tracheostomy: NCEPOD. 2014, London, http://www.ncepod.org.uk/2014tc.htm Accessed 30 August 2014Google Scholar
  3. Taylor C, Barrass L, Drewery H: Training for tracheostomy. British Journal of Anaesthesia. 2013, 111: 842-3. 10.1093/bja/aet367.PubMedView ArticleGoogle Scholar

Copyright

© Paton et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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