Russel C, Matta B (Eds): Tracheostomy – A Multiprofessional Handbook, 1st edition. San Francisco, CA: Greenwich Medical Media Limited; 2004. 392 pp. Price £19.50 (US$32.99)
© BioMed Central Ltd 2004
Published: 20 October 2004
Keywordsairways nursing infection nutrition respiratory failure team approach tracheostomy
Tracheostomy is one of the most frequent procedures performed on critically ill patients. It has advantages compared with translaryngeal endotracheal intubation, such as reduced laryngeal anatomical alterations, reduced inspiratory load, better tolerance by the patient and better nursing. Thus, tracheostomy can ease a patient's care in the event of prolonged respiratory support and difficult weaning, for different categories of patients. Different targets need to be addressed for tracheostomy: first, the patient's selection; second, the optimal timing; third, the tracheostomy technique to be used in relation to the anatomical and clinical characteristics of the patient; fourth, and most importantly, the overall clinical management of the tracheostomy and the patient as an individual have to be carefully considered. In this respect, the authors of this book have to be congratulated because they have focused not only on specific technical problems related to the daily management of tracheostomy but also on the patient's general clinical management including infective and nutritional aspects. For this purpose the editors brought together a balanced team clinically active in the field to provide a comprehensive review of tracheostomy-related problems. A multidisciplinary team approach can improve the care of patients with tracheostomies. These dedicated teams, composed of doctors, nurses, speech therapists, physiotherapists and dietetic staff, daily have to work closely and in a coordinated manner to ensure all the needs of these patients to improve their clinical and psychological outcome. We believe that this is the most important message from this book, emphasizing the crucial role of each specialist to determine the appropriate achievement of the targets when tracheostomy has to be performed.
It is a 392-page paperback book with 22 chapters covering the following topics: first, the upper airway and respiratory basic anatomy; second, the technical basis of tracheostomy and how it alters the upper airway's anatomy; third, the description of different tracheostomy tubes and surgical or percutaneous tracheostomy approaches; fourth, the medical and nursing care of tracheostomy in the early phase after the operation and in the long term, including humidification, suctioning, wound care, swallowing and communication; fifth, the problems related to changing the tracheostomy tube and decannulation; sixth, particular attention to the technical and practical problems of tracheostomy of children; seventh, infection management and nutritional care of the tracheostomized patient.
Particularly important are the sections dedicated to tracheostomy problems in children. Tracheostomy in children is not as common as in adults, but when it occurs both the technical aspects, namely tracheostomy timing and technique, and clinical management are particularly difficult even for more experienced doctors. Moreover, few contributions have been published on this specific aspect. In this book the authors describe the main differences in anatomy, tracheostomy tubes, techniques, and nursing management between tracheostomy in children and in adults. Extremely emotional is the report of the parents of a tracheostomized daughter describing aspects of their practical experience and psychological behaviour. It looks like a charming tale but it gives important information to doctors and nurses that are generally unrecognized and unconsidered.
Surprisingly poor is the section dedicated to percutaneous techniques. The authors mention only one specific dilational technique. It should be remembered that several percutaneous techniques, intrusive and extrusive, are now commercially available and each of them has advantages and disadvantages that have to be addressed individually when a specific tracheostomy technique is chosen for the individual patient.
This book is characterized by a standard and effective chapter format that first sets out the basics of physiology and anatomy, then key aspects of technical and clinical management, and finally a brief summary of the main topics discussed in the chapter. Practical procedures are clearly described and throughout the text there is effective use of bullet points and text boxes that highlight key messages. I particularly liked illustrations of technical procedures and easily read flowcharts describing clinical management and indications and contraindications for each technique. Furthermore, the authors based their management plans on high-quality evidence and outcome research, although such data are extremely scanty and controversial in the scientific literature. The references quoted are relevant, most having been published within the past 5 years, and represent a further help to the reader who wishes to deal in more detail with a specific clinical or technical aspect. However, some website addresses at the end of each chapter could have been helpful for a further systematic review.
This book is aimed in particular at doctors involved in respiratory care, surgeons dealing with thoracic and head–neck surgery, and intensivists. Even more importantly, the book will be particularly valuable to junior doctors and residents from a variety of backgrounds who become involved in the care of tracheostomized patients, and to qualified nurses specializing in this area. Indeed there are very few, in our opinion, who would not learn something from it.
We believe that this book will provide incalculable help in the daily practical management of tracheostomized patients, suggesting that a multidisciplinary approach is essential for improving the care of patients with tracheostomies.