Feedback on ‘Tracheostomy management’, BJA Education, June 2015

Abstract

Editor®I wish to comment on behalf of my colleagues who work with the National Tracheostomy Safety Project in response to the article by Katharine Hunt and Sue McGowan in the June edition of BJA Education.1Hunt K McGowan S. Tracheostomy management.BJA Education. 2015; 15: 149-153Abstract Full Text Full Text PDF Scopus (5) Google Scholar The article updates the reader on some of the progress in multidisciplinary tracheostomy care in the intervening years since a similar article in April 2008's CEACCP journal. It was refreshing to see the contribution of a nationally recognized Speech and Language Therapist in this latest article, emphasizing some of the progress in multidisciplinary care and management of tracheostomy patients. We were very surprised however not to find any mention of the National Tracheostomy Safety Project (NTSP), especially when many of the NTSP resources were considered as the benchmark in the 2014 NCEPOD report ‘On the right trach?’ referred to in the article. The Intensive Care Society Guidelines referenced in the article were updated in June 2014 and again emphasize the importance of standardized (NTSP) guidelines. The reproduction of Hunt and Regan's 2008 emergency management guideline figure was also surprising and potentially misleading for the readership of BJA Education. The NTSP published multidisciplinary emergency guidelines in 2012 (Fig. 1) which were endorsed by the Royal College of Anaesthetists, the Difficult Airway Society, the Intensive Care Society, ENT UK, the British Association of Oral and Maxillofacial Surgeons, the College of Emergency Medicine, the Resuscitation Council (UK) the Royal College of Nursing, the Royal College of Speech and Language Therapists, the Association of Chartered Physiotherapists in Respiratory Care, and the National Patient Safety Agency.2McGrath BA Bates L Atkinson D Moore JA Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies.Anaesthesia. 2012; 67: 1025-1041Crossref PubMed Scopus (134) Google Scholar The algorithms are universally taught in this country and beyond and were developed primarily in an attempt to standardize the response to tracheostomy emergencies. Whilst we certainly do not claim ownership of emergency care for tracheostomy patients, to publish alternative guidance without reference to the current national standard is confusing at best. The NTSP algorithms have been tested in both Anaesthetic and Intensive Care Medicine examinations and we would like to draw attention to this for your readership, especially those who are searching for up-to-date resources or specifically revising for such examinations. The article also makes valid reference to role anaesthetists can play as part of a multidisciplinary team managing in patients with a tracheostomy. The weaning process described is one of many published strategies and we would direct the reader searching for additional resources to the websites of the NTSP (www.tracheostomy.org.uk) or that of the Global Tracheostomy Collaborative (www.globaltrach.org).