Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran
| Autor: | Majid Golestani Eraghi, Neda Doozandeh Tabarestani, R Farzanegan, Mohammad Behgam Shadmehr, Mahdi Zangi, Shahram Noorbakhsh, Behrooz Farzanegan |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Pediatrics
medicine.medical_specialty Stridor medicine.medical_treatment 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine law Intensive care medicine Intubation Lost to follow-up Prospective cohort study Stenosis business.industry Feasibility General Medicine medicine.disease Intensive care unit Tracheal Stenosis Policy 030228 respiratory system Tracheal Emergency medicine Study Lost to Follow-Up medicine.symptom business Research Article |
| Zdroj: | Iranian Red Crescent Medical Journal |
| ISSN: | 2074-1804 |
| Popis: | Background Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most common reason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may vary in different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to an intensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibility step was also designed to examine the whole project and to enhance the follow-up rate. Objectives To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study. Methods This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November 2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included. Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successful follow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of any symptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometry and then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis. Results Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents (52%) was the most common cause of intubation. Follow-ups were completed in only 14 (19.2%, CI = 0.109 - 0.300) patients. One patient (7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successful follow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, and difficulties to attending follow-up visits. There were also some important obstacles in terms of human, time, material, and cost resources, as well as data management. Conclusions To enhance the follow-up rate, three strategies were proposed: patient-focused strategies such as emphasizing patient education upon discharge and providing rewards; structural-focused strategies such as scheduling home visits and uploading questionnaires onto the research center's website; and provider-focused strategies such as selecting coordinators with good communication skills. All necessary resources should also be re-arranged for a multicenter national study. |
| Databáze: | OpenAIRE |
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