Focus on patient safety - « Tracheostomised patients in the critical care setting... Tracheostomy, when life hangs by a tube »

Context

In 2019, the French national survey of serious care-related adverse events in healthcare facilities revealed that such events continued to occur in critical care departments and that, in contrast with other sectors, their incidence density had not decreased in these settings since 2009. [1] [2] An analysis of critical care-related serious adverse events reported by healthcare professionals revealed that the insertion and management of tracheostomy tubes could be implicated in the occurrence of very often avoidable serious adverse events. Given that tracheostomy is a common procedure in intensive care settings, but with considerable disparities between teams in terms of frequency (from 5% to 54%) and techniques (surgical or percutaneous), [3] it seemed important to publish feedback on this subject. 

Objectives

By sharing feedback relative to the occurrence of serious adverse events during the management of tracheostomies, this Focus on patient safety aims to: 

• alert healthcare professionals and care teams about the occurrence of serious care-related adverse events that could have been avoided by following good clinical practice;  
• help reduce the risks related to tracheostomy management;
• improve information and training for healthcare personnel on good clinical practice for tracheostomy management.

So it doesn’t happen again

Based on an analysis of the serious care-related adverse events reported, they are usually caused by inadequate training of personnel, the absence of a department procedure, poor practice or a failure to monitor the patient. 

Main key messages to prevent these events:  

• Always assess the benefit-risk balance of a tracheostomy and the choice of technique.
• Always have trained personnel insert, maintain and monitor tracheostomies.
• Always hold a pre-job briefing before performing technical procedures associated with the insertion or management of a tracheostomy tube [4].

[1] https://sante.gouv.fr/IMG/pdf/eneis_3_2019_.pdf 

[2] https://sante.gouv.fr/IMG/pdf/p_michel_et_al__article_beh_juin_2022_resultats_eneis3_etablissements_de_sante.pdf 

[3] Société de réanimation de langue française [French-language intensive care society], Société française d’anesthésie et de réanimation [French Society of Anaesthesia and Intensive Care], Trouillet JL, Collange O, Belafia F, Blot F, et al. Trachéotomie en réanimation. Recommandations formalisées d’experts. [Tracheostomy in intensive care settings. Formalised expert recommendations.] Paris; 2016 

[4] Haute Autorité de santé. Briefing. Saint-Denis La Plaine: HAS; 2016