Medical High Dependency Unit series, Article 4: Tracheostomy management

Abstract

The number of patients with tracheostomies managed within high dependency units is increasing. National audits have suggested that the care of these patients could have been improved upon with a significant minority of cases resulting in death or serious adverse events. Because of this, it is crucial that staff working within medical high dependency units have a good understanding of the indications for and techniques of insertion of tracheostomies. In addition, knowledge of the various tube types and ancillary equipment is mandatory. Ideally, care should be standardised across hospital sites and all staff trained to deal with routine and basic emergency care using national guidelines. It is fundamental that medical staff without expertise in the advanced management of emergencies are aware of the equipment required and who to contact within their hospital should such procedures be necessary. Temporary tracheostomies should be removed at the earliest opportunity under the guidance of the teams responsible for their insertion.