• Denise P Veelo, Marcus J Schultz, Kai Y N Phoa, Dave A Dongelmans, Jan M Binnekade, and Peter E Spronk.
• Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.p.veelo@amc.uva.nl
• Resp Care. 2008 Dec 1;53(12):1709-15.

ObjectiveTo determine tracheostomy-management practices in Dutch intensive care units (ICUs) and post-ICU step-down facilities.MethodsWe surveyed the physician medical directors of all Dutch nonpediatric ICUs that have > or = 5 beds suitable for mechanical ventilation. The survey asked for demographic information about the hospital and ICU setting, and for information and opinions about tracheostomy management in the ICU and step-down facilities, and the use of tracheostomy-management guidelines.ResultsForty-four of the 69 ICUs responded. Sixty-four percent of the respondent ICUs only deflate the cuff when the patient is breathing spontaneously, without assistance from the ventilator. Fifty-nine percent do not routinely change the tracheostomy tube. Almost half use inner cannulas in tracheostomy tubes. Overall, intensivists were most often involved in the follow-up of discharged tracheostomized patients. In the nonacademic hospitals, specialized ICU nurses were more often involved (P = .05). Sixty-four percent indicated they have no guideline for managing discharged tracheostomized patients. There was a diversity of opinion (median visual-analog-scale score 5.0, 95% confidence interval 3.0 to 8.0) on whether the tracheostomy tube should be removed "at once" or after "down-sizing."ConclusionsThere were large differences in tracheostomy management among Dutch ICUs. ICU and post-ICU tracheostomy-management guidelines are lacking and needed.

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