A comparative study of systemized vs. random tracheostomy weaning.

The purpose of this study was to compare a systematic tracheostomy weaning procedure to a random weaning approach by asking the question: "What is the benefit to the patient of a systematic vs. random weaning process for tracheostomy removal as defined by the number of weaning attempts and post-weaning complications?" A tracheostomy weaning procedure was developed at St. Boniface General Hospital as a joint venture between the neuroscience nurses and neurosurgeons in response to a perceived clinical need. This project evaluated the systemic procedure in two neuroscience units in Manitoba on ten adult patients who met the assessment criteria for tracheostomy removal established in the procedure. The patients were monitored for thirty days post removal for complications. In addition, a retrospective chart review was completed on twenty charts of patients who had undergone random tracheostomy weaning from 1990-1992. Content analysis of the documentation immediately before, during and after each tracheostomy weaning procedure was undertaken. The results of the study indicate that there were fewer weaning attempts required for the patients with the systemized procedure than the random procedure, and although not statistically significant, there were fewer post-removal complications per patient in the systemized procedure than with the random procedure. Content analysis of the retrospective data indicates that the random tracheostomy weaning procedure was subject to the individual nurses' judgement. The systemized procedure was more standardized and conformed to the protocols in the procedure. Most importantly, the patient's comfort and safety were greatly enhanced through the use of standard tracheostomy weaning procedure.