January 2023 Wound and Ostomy Journal
Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis.
Please click the Link Below:
Please follow Journal Rules and Guidelines before posting.If not automatically directed on the PDF file just click Download PDF file on the Headings tab.
Don't forget to write your name with each posting.
1. Discuss the sample size used in the study.
ReplyDeleteA total of 3846 studies were identified, and the full texts of 56 studies were reviewed for eligibility. Ten studies published between 2012 and 2020 were included for synthesis. They consisted of 2 randomized clinical trials (RCTs), 5 quasi-experimental studies, and 3 observational studies of hospitalized adult and pediatric patients. The studies involve a total of 2023 participants, of whom 1428 were children and 595 were adults.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
The study was limited to in-patient settings, so the limitation is in being able to apply the study findings to out-patient settings such as long-term acute care facilities and/or subacute care facilities. As the author mentioned, early detection and intervention for tracheostomy complications are critical for patients cared for outside hospital settings.
Describe the method used by the author of the study.
ReplyDeleteMidline, Embase, Cinahal and the Cochrane Library were search for studies to evaluate interventions to refuse tracheostomy related pressure injury. A clinical information it’s provided the expertise in constructing the electronic search strategy which included querying Medline, Embase, Cinahal and the Cochrane Library.
Was the correct method used? Why or why not?
Yes. The correct method was used because the results of the the ten studies shows patient met eligibility criteria. The incidence of tracheostomy related pressure injury was 17.0 % before intervention and 3.5% after intervention. Meta analysis supported the benefit of hydrophilic dressings under tracheostomy flanges for decreasing tracheostomy related pressure injury.
Bethany Sobesto 4/4/23
ReplyDeleteDescribe the method used by the author of the study.
In this study they used a systematic review, with meta-analysis, using PRISMA. The data was taken from Medline, Embase, CINAHL, the Cochrane Library, and unpublished studies of clinical trails.
Discuss the limitations of the article.
Some concerns for bias were shown. There was also some limitation in the sensitivity of the measurement tools.
Discuss the sample size used in the study.
Ten studies were used for synthesis. 2023 critically ill adults and pediatrics were included in the study.
ReplyDeleteDiscuss the limitations of the article
1. Lack of validated measurement tools. According to the article, studies used assessment tools developed for skin injury but not particularly to classify pressure injury related to peristomal anatomy.The article suggested a need for standardize tracheostomy related pressure injury identification and staging.
2. Studies that reviewed internal complications such as airway device malposition and tracheal ulceration were not included to narrow the scope of study.
3.Exclusion of patients outside hospital settings. Prevention and early detection should be regarded to prevent risk for life threatening infections
What are the advantages of implementing the article recommendations in your hospital?
The article findings showed that hydrophilic foam dressings reduces tracheotomy related pressure injury by providing cushion and prevent accumulation of excess moisture. Foam collars is beneficial as well, not only that it enhances absorbing moisture , but also achieves a wider pressure distribution on skin reducing risk of pressure injury. In PSJMC, we use Lyofoam T sterile dressing and tracheostomy foam ties and with inclusion of inter professional collaboration and communication promote patient's safety and preventing tracheostomy related pressure injury. Medical related pressure injuries such as tracheostomy can be painful and costly but can be prevented.
1)Discuss the sample size used in the study.
ReplyDeleteThe study was a literature review and meta-analysis to investigate tracheostomy-related pressure injury incidence and to evaluate injury prevention strategies. out of 3846 studies identified, ten studies published between 2012 and 2020 were included for synthesis.
2)how does this research article compare to our practice, policy and/or procedure?
Interventions mentioned were the use of hydrophilic dressings and foam trach collars. we are currently using both products with very good results. there is no noticeable moisture retention or skin breakdown that I've noticed in my practice. it would have been helpful to have known the prevention bundle that was referenced in the article. It was very impressive to note in the article that after intervention, the trach pressure injury incidence dropped by 79%.
1. Describe the method used by the author of the study
ReplyDeleteThis article is a systematic review with meta- analysis of studies related with interventions to prevent medical device–related pressure injuries associated with tracheostomy tubes in critical health care settings, including observational or experimental designs with a comparison group. Articles from MEDLINE, Embase, CINAHL and the Cochrane Library are searched to evaluate the intervention by reviewers independently and assessed by the Cochrane Collaboration’s risk-of-bias criteria. Descriptive and quantitative data were extracted also independently by paired reviewers using a prestandardized data extraction form
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
Even though the study incorporated an assessment of injury, using either ( 1) the National Pressure Injury Advisory Panel (NPIAP) staging scale, which measures tissue integrity from stage 0 (healthy tissue) to 4 (deep tissue pressure injury),[25] or ( 2) nonstandard descriptions or interpretations of pressure injuries derived from medical records, the study did not include the validated measures of pressure injuries.
This article was reviewed limitedly to studies in the critical care environment, it does not have long term effect of the hydrophilic dressing for tracheostomy flanges and foam tracheostomy collars outside of hospital setting such as subacute care facility.
In this article, internal complications such as tracheal ulceration, internal airway damage, or airway device malposition were not examined, leading to narrow the scope of the study and in keeping with its emphasis on readily observable tracheostomy-related pressure injuries for frontline health care professionals
1. Describe the method used by the author.
ReplyDeleteThis article is a review of several different studies. This meta analysis approach allows authors to crunch data quantitatively from other articles and then strain through different variables in order to find conclusions or limitations. The result is a generalized summary statistic.
2. How does this research article compare to our practice.
Proudly PSJMC does use both products that this article concluded were beneficial for the prevention of trach related pressure injuries- the foam trach ties and hydrophilic dressings. I recall before Lyofoam, simple 4x4 split gauze was the standard. Now newer products such as Lyofoam incorporate the hydrophilic properties that this article concludes are beneficial. And foam trach ties remain the standard.
what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDeletePSJMC uses a specific Lyofoam T sterile dressing and tracheostomy foam ties to reduce moisture and prevent the breakdown of skin. The article provides several different methods to prevent skin breakdown. For a new product to be implemented at the hospital, there would need to e proper and adequate education provided to staff of units who care for tracheostomy patients. Without proper education and instruction dressing changes my not be done or incorrectly completed and therefore increase the risk of skin breakdown for the patient.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The overall study was limited to the inpatient setting. We are unable to determine data from Ltachs, long term care facilities, etc. where patients can live long term without acute disease processes. Without comparing inpatient to outpatient data we are unable to see the care provided to these patients. Patients outside the acute care hospital can still develop tracheostomy related pressure injuries if required for prolonged use.
1)How does this research compare to our practice/policy/procedure?
ReplyDeleteThe article describes use of tracheostomy foam and ties which is being utilize with our vent/trach patients in our unit. It has shown to prevent trach related pressure injuries . When Tracheostomy bundle is implemented per policy , patients are less to be predisposed to infection.
2)What are the advantages and disadvantages to the proposed recommendations in the article:
When trach bundle is initiated and implemented throughout patients stay in the hospital , there will be less concerns about developing pressure injuries or infections r/t to the device. The disadvantage would be when nurses are not consistent with care.
David K RN.
ReplyDelete1)Describe the method used by the author of the study:
Randomized clinical trials. The author reviewed multiple acute care studies and compilied data from these.
2)Limitations of the study:
These studies were performed at acute care hospitals that all used different supplies and various pressure reducing techniques. The scale and ranking of the types of pressure ulcers was also not standardized and subjective.
These limitations lead to significant fluctuations in results. For example when comparing types of trach ties used and correlating that to incidence of pressure ulcers; 1 hospital reported aprox 64% decrease in pressure ulcer incidence, while another hospital report only a 8.6% decrease. This study does not take the human care element into consideration.
Because of that it is hard to say how useful the information can be if it is not taking into account hospital/unit policy and adherence to those policies.
1) Describe the method used by the author of the study.
ReplyDeleteThe method used was the systematic review, Midline, Embase, Cinahal, and Cochrane Library data was used. There were multiple studies reviewed and compare.
2) How dose this research article compare to our practice, policy and/or procedure.
In the article hydrophilic dressing and trach foam are used. Our hospital uses the same products and i find it very successful, those products are very good tools in preventing pressure wounds, skin breakdown.
1) Describe the method used by the author of the study:
ReplyDeleteRandomized clinical trials. The author reviewed multiple acute care studies and collected data. This page provides a summary of many studies. By using a meta-analysis strategy, authors can objectively analyze data from other studies and then shift through many variables to identify findings or limitations. A generalized summary statistic is the outcome.
2) How dose this research article compare to our practice, policy and/or procedure.
The foam trach ties and hydrophilic dressings, which this investigation concluded were helpful for preventing trach-related pressure injuries, are used by PSJMC. In the article, trach foam and hydrophilic dressing are both employed. The same goods are used at our hospital, which I believe to be quite helpful; they are excellent instruments for minimizing pressure wounds and skin breakdown.
Luna Chowdhury
1. Discuss the sample size used in the study.
ReplyDeleteTen studies (2 randomized clinical trials, 5 quasi-experimental, 3 observational) involving 2023 critically ill adult and pediatric patients met eligibility criteria.
2. Describe the method used by the author of the study.
A clinical information list provided expertise in constructing the electronic search strategy, which included querying MEDLINE, CINAHL, Embase, and the Cochrane Library. This article is a systematic review with meta- analysis of studies related with interventions to prevent medical device–related pressure injuries associated with tracheostomy tubes in critical health care settings, including observational or experimental designs with a comparison group.
How does this research compare to our practice/policy/procedure?
ReplyDeleteThe interventions in this journal are very effective in preventing
tracheostomy related pressure injury. The incidence of tracheostomy related PI was 17% before the interventions and 3.5% after the interventions, a 79% decrease. These interventions include modifications to the tracheostomy flange securement with foam collar hydrophilic dressings and extended-length tracheostomy tubes. PSJMC tracheostomy care include the following:
Tracheostomy sutures may be removed 10 days postoperatively, Tracheostomy stoma care to be performed by registered nurse (RN) each shift and as needed, (placement of a hydrocolloid dressing Allevyn underneath the tracheostomy flange), Replace disposable inner cannula each shift and as needed.
2)Discuss the sample size used in the study.
2023 critically ill patients were included in the study. Of the 2023,1428 were children with a mean age of approximately 26 months.
Describe the method used by the author of the study: In order to investigate tracheostomy-related pressure injuries and evaluate the effectiveness of strategies for preventing such injuries in icu patients, Chandler H. Moser et al., 2022, use a systematic review process in conjunction with meta analysis study strategies. The study gathered data using electronic search strategy using the Medline, Cinahl, Embase, and the Cochran library beginning in February 2021 to the present date. Then, using predetermined exclusionary criteria, the researchers focused on and selected studies that used human models to study the effects of interventions in preventing medical device related pressure injuries related to the use of tracheostomy tubes. Lastly, the National Pressure Injury Advisory Panel staging scales were used to assess and scale the degrees of injury.
ReplyDeleteDiscuss the sample size used in the study: Post electronic search of 3846 studies, removal of duplicates, exclusion of irrelevant studies and River of further eligibility of the remaining 56 studies (published between 2012 and 2020) the researches included 2 randomized clinical trials, 5 quasi experimental studies and 3 observational studies of critically I’ll patients, of all the studies included, the total participant count was 2023, of which 1428 were children in its mean ago of approximately of 26 months.
2) How dose this research article compare to our practice, policy and/or procedure.
ReplyDeleteThe foam trach ties and hydrophilic dressings, which this investigation concluded were helpful for preventing trach-related pressure injuries, are used by PSJMC. In the article, trach foam and hydrophilic dressing are both employed. The same goods are used at our hospital, which I believe to be quite helpful; they are excellent instruments for minimizing pressure wounds and skin breakdown.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
PSJMC uses a specific Lyofoam T sterile dressing and tracheostomy foam ties to reduce moisture and prevent the breakdown of skin. The article provides several different methods to prevent skin breakdown. For a new product to be implemented at the hospital, there would need to e proper and adequate education provided to staff of units who care for tracheostomy patients. Without proper education and instruction dressing changes my not be done or incorrectly completed and therefore increase the risk of skin breakdown for the patient.
Describe the method used by the author of the study
ReplyDeleteA systematic review with meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered with the international prospective register of systematic reviews (PROSPERO registration #CRD42021238918).[23] The systematic review was executed using the Covidence online literature review platform. A clinical informationist provided expertise in constructing the electronic search strategy, which included querying MEDLINE, CINAHL, Embase, and the Cochrane Library from inception to February 2021.
Discuss the sample size used in the study.
A total of 3846 studies were identified, and 1441 duplicates were removed. Of the 2405 studies available for title and abstract screening, 2349 were not relevant and excluded. A total of 10 studies of the 3846 were used. They consisted of 2 randomized clinical trials, 5 quasi-experimental studies, and 3 observational studies of critically ill adult and pediatric patients. The studies involved 2023 participants, of whom 1428 were children with a mean age of approximately 26 months.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis study evaluates the effectiveness of measures used to reduce trach related pressure injuries. This is pertinent to our practice because we see many patients with trachs, and need to do what we can to prevent pressure injuries associated with them. We can do this by using evidence based practice to find the best methods to prevent trach related pressure injuries.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
A flaw in this study about trach related pressure injuries is that prevention bundles were used in the study. This made it difficult to assess the effectiveness of individual prevention measures. Of the bundle of prevention measures used, it cannot be said which ones were effective and which ones weren't even if the outcome was favorable.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe article discusses the use and benefits of using trach foam ties and hydrophilic dressings to help reduce the occurrence of skin breakdown at the tracheostomy site. Currently at Providence St. Joseph Medical Center, we use both of these skin breakdown prevention techniques to help provide the best skin care around the trach site and help reduce the occurrence of skin breakdown by means of frequent assessment and care.
2. Discuss the sample size used in the study.
The sample size of the study included 10 different studies for synthesis between the timeframe of 2012 to 2020. The studies were conducted primarily in the United States and consisted of 2 randomized clinical trials, 5 quasi-experimental studies, and 3 observational studies of critically ill adult and pediatric patients. The studies involved 2023 participants, of whom 1428 were children with a mean age of approximately 26 months.