• Mary Lou Sole, Steven Talbert, Daleen Aragon Penoyer, Melody Bennett, Steven Sokol, and Jason Wilson.
• Author Affiliations: Interim Dean and Orlando Health Distinguished Professor, College of Nursing, University of Central Florida, Orlando, and Clinical Scientist, Orlando Health, Florida (Dr Sole); Assistant Professor (Dr Talbert) and Research Project Director (Ms Bennett), College of Nursing, University of Central Florida, Orlando; Director (Dr Penoyer), Center for Nursing Research, Orlando Health, Florida; and Clinical Informatics Specialist I (Mr Sokol), Dr P. Phillips IS Clinical Information Services, Orlando, Florida; and Consultant (Mr Wilson), WeiserMazars, LLP, Smart Solutions Healthcare Group, New York and Central Florida.
• Clin Nurse Spec. 2014 Sep 1; 28 (5): 288-95.

Purpose/ObjectivesMany critically ill patients require a tracheostomy when unable to be weaned from prolonged ventilator support. This study describes the characteristics, resource use, and outcomes of patients who required a tracheostomy for failure to wean from mechanical ventilation.DesignA retrospective descriptive study was conducted to analyze data from the electronic medical record and hospital databases.SettingThe setting was a tertiary care hospital with a level I trauma center.SampleData from 363 adult subjects who underwent a tracheostomy after prolonged mechanical ventilation during a 1-year period were obtained from hospital databases. All underwent a percutaneous procedure. The majority of subjects were male (62.8%) and white (57.9%), with a median age of 59 years. Nearly half had a trauma diagnosis.ResultsHospital mortality was low (9.9%). Ventilator days, hospital/intensive care unit lengths of stay, and costs were high. Only 7.1% of subjects were discharged directly from the hospital to home. Others were transferred to long-term acute-care hospitals, rehabilitation centers, skilled nursing facilities, and other hospitals. Those who had the tracheostomy done prior to 10 days of ventilation had better outcomes; however, these same subjects had lower acuity scores. Within 1 day of the procedure, ventilator settings were reduced, airway pressures were lower, and level of sedation was improved.ConclusionsPatients requiring a tracheostomy incur high resource use, and although the majority was transferred to other facilities, the number discharged directly home was low. Improved physiological parameters and reduced ventilator settings following the tracheostomy facilitated weaning from ventilation.ImplicationsKnowledge of characteristics and outcomes may assist in identifying interventions to reduce the need for tracheostomy or improve outcomes. In particular, the clinical nurse specialist can lead team initiatives to promote weaning prior rather than performing a tracheostomy as well as interventions postprocedure to improve discharge outcomes.

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