الفهرس 
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Abstract
Tracheostomy is among the most frequently performed procedure in
critically ill patients, the benefits of tracheostomy over prolonged
intubation are: reduced use of sedation, reduced trauma to the oropharynx
and larynx, reduced work of breathing and improved clearance of
pulmonary secretion, decreased periods of mechanical ventilation and
consequently length of ICU and hospital stay. Patients, who had prolonged
tracheal intubation and consequently had late tracheostomy, had more
complications; airway injuries and ventilator- associated pneumonia than
those who underwent early tracheostomy.
The aim of this study
To investigate the implementation of nursing practice for
tracheostomy care of critically ill trauma patients who have tracheostomies,
to provide an update on guidelines for total care to the tracheostomy.
The study was conducted at the (ICU) of Assiut University Hospital.
The sample of the study was in the form of convenient sample that
consisted of 60 adult patients (male and female) divided equally into two
groups (early and late tracheostomy).
first group which tracheostomy was performed within the first 7 days
of initiation of mechanical ventilation and the late tracheostomy group
which tracheostomy was performed after 7 days of initiation of mechanical
ventilation at any time.
Our study excluded all patients with history of previous trauma but
admitted to the ICU for other reasons, chronic lung disease and
Readmission to the ICU and trauma referrals from other hospitals. Tools of the study
Three tools designed and used by the researcher for collecting data
for this study.
Tool (1) physical assessments data structured interview schedule:-
This tool was applied by the researcher after reviewing the related
literature. It includes five parts:-
Part 1:-patient’s socio-demographic data such as age and six.
Part 2:- patient clinical data such as date of admission, vital signs, cause of
trauma, site of trauma, mechanical ventilation data and medical
diagnosis.
Part 3:- Acute physiology and chronic health Evaluation score (APACHE
II):
Part 4:- injury severity score (ISS):
Part 5:- Glasgow coma scale:
Second tool: - ”tracheostomy assessment sheet”
Third tool:-
Evaluation sheet: - the aim of this tool was to assess the patient for the
presence of signs and symptoms of infection.
The main results
Regarding to length of stay in ICU the current study results found
that early tracheostomy patients had shorter length of stay in the ICU than
late tracheostomy. As regard to patient’s condition the current study revealed that (100%)
of early tracheostomy had improved while (46.7%) of late tracheostomy
had improved.
Regarding to discharges from trachea the current study results found
that almost of the early tracheostomy had white secretion (56.7%) and
almost of the late tracheostomy (86.7%) had yellowish secretion
The finding of the current study related to body temperature revealed
that there were highly statistical significance decreases in early
tracheostomy than late tracheostomy.
The results of the current study revealed that the majority of the early
tracheostomy had normal breath sound (50%) at the first day, while (0.0%)
of the late tracheostomy had normal breath sound at the first day,
comparing with the seventh day the results revealed that (76.7%) of the
early tracheostomy had normal breath sound, while (10%) of the late
tracheostomy had normal breath sound at the seventh day,
Regarding to timing of tracheostomy the results of the current study
revealed that (16.7%)of early tracheostomy patients and(0.0%)of late
tracheostomy patients had weaned from mechanical ventilation from 1to 3
days while (53.3%)of early tracheostomy patients and(6.7%)of late
tracheostomy patients had weaned from mechanical ventilation from 4 to 6
days and (30%) of early tracheostomy and (93.3%) of late tracheostomy
patients had weaned from mechanical ventilation in more than 7 days,
while (10%)of early tracheostomy and(0.0%) of late tracheostomy patients
had Decannulated from tracheostomy from 4 to 6 days, the results showed
significant reduction in duration of mechanical ventilation and timing of
tracheostomy.
Summary
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As regard to Glasgow coma score and injury severity score the
results of the current study revealed that there were no significant
difference between two groups in the 1st and 4th day of the study while
there were high statistical significant difference between two groups in the
7th day of the study early tracheostomy show improvement in GCS than
late tracheostomy, and APACHE II score the results of the current study
revealed that highly statistical significant difference between two groups in
all study intervals
As regard to respiratory secretion culture the results of the current
study revealed that (50.0%) of the early tracheostomy group had positive
respiratory secretion culture at the 1st day increased to (66.7%) at the 4th
day while (83.3%) of the late tracheostomy group had positive respiratory
secretion culture at the 1st day increased to (90%) at the 4th day.
Regarding to white blood cells the results of the current study
revealed that there is highly statistical significant difference between early
and late tracheostomy in all days of the study, early tracheostomy improves
white blood cells.
Based on the current study finding it was recommended that:
Hospitals should implement protocols for tracheostomy patient on
mechanical ventilation that includes each of the practices recommended by
the centers for disease control and prevention. Established hand washing to prevent nosocomial respiratory tract
infection. It is recommend placement and use of hand washing facilities in each
unit (sink, antimicrobial soap, proper towel for draying).