This study performed a systematic review to identify evidence-based guidelines for the management of adult tracheostomy patients. A search of several databases and websites yielded 80 guidelines, of which only 5 met criteria for rigorous development. Of those, 3 addressed the full spectrum of tracheostomy care. The results indicate a lack of high-quality evidence-based guidelines for tracheostomy management, highlighting a need for more clinical research and international consensus on best practices.

1. Evidence-based guidelines and protocols for the management of
adult patients with a tracheostomy: a systematic review.
Siddiqui J , Sherren PB , Birchall MA .
1
2
3
1. Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK
2. Royal Free Hampstead NHS Trust, London, UK
3. Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS
Trust, London, UK
Introduction
Methods
A systematic search of Pubmed, Medline, guideline clearinghouses, centres of evidence-based
practice, and professional societies’ guidelines relating to care of adult patients with a tracheostomy
was performed by two reviewers. In addition, a Google search of publicly available tracheostomy care
guidelines and protocols was performed.
Rigorous and protocol-based
care of the adult patient with a
tracheostomy is important, both
within hospital and in the
community; adverse events,
although rare, confer a high rate
of mortality [1]. Although many
informal or local guidelines and
protocols exist, little is known
regarding the existence and
availability of formal evidencebased guidelines on adult
tracheostomy care.
Search terms: (Tracheostom* OR tracheotom*) AND (protocol* OR guideline* OR standard* OR
management OR consensus OR algorithm*).
Filters: English language, Human, from 01/01/1990 to date, adult patients.
Guideline appraisal criteria: The quality of guidelines retrieved was assessed using the Appraisal of
Guidelines Research and Evaluation II (AGREE II) instrument [2], utilising criteria 8 and 12 of the rigour
of development domain.
Results
The aim of this study was to
perform a preliminary
systematic review for evidencebased guidelines on adult
tracheostomy care.
Table 1
Database
The search results are summarised in table 1.
A total of 80 guidelines were identified and five were found to satisfy the AGREE II criteria. Of these,
only three related to the entire spectrum of tracheostomy management.
The majority were informal, ad-hoc guidelines that were not published or evidence-based.
Results with
limits
Full texts
retrieved
4685
1596
33
3859
1337
733
172
N/A
3
6
N/A
2
17
CINAHL
AGREE
instrument
compliant
54
Medline
Guidelines found
26
Pubmed
Total results
N/A
Medical
Societies /
Guideline
websites
/Clearinghouses
Google
17,600,000
497
N/A
Conclusion
Five evidence-based guidelines on
adult tracheostomy management
were identified. This may represent
a paucity of evidence on the
subject, suggesting that further
clinical trials on the topic are
needed to contribute to the
evidence-base. In addition, this
highlights the need for international
consensus in the area, to reduce
duplication of efforts, standardise
practice, and improve outcomes.
References
1.McGrath BA et al. Anaesthesia. 2012
Sep;67(9):1025-41.
2.The AGREE Collaboration. 2001.
Appraisal of Guidelines for Research and
Evaluation: Instrument. AGREE II.
http://www.agreetrust.org/