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This version was published on November 1, 2007
American Journal of Hospice and Palliative Medicine®, Vol. 24, No. 5, 371-375 (2007)
DOI: 10.1177/1049909107300214

What About the Trach? Tracheotomy Removal as a Palliative Care Maneuver

Alfred J. Newman, III, MD

Matthews Hematology Oncology Associates, Matthews, North Carolina

Elizabeth A. Kvale, MD

Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham

Beverly R. Williams, PhD

Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham, Birmingham VA Medical Center Birmingham, Alabama

F. Amos Bailey, MD, FACP

Division of Geriatrics, Gerontology, and Palliative Care, University of Alabama at Birmingham, Birmingham VA Medical Center Birmingham, Alabama, amos.bailey{at}va.gov

Tracheotomy is performed on patients with airway obstruction or prolonged mechanical ventilation. Tracheotomy patients are increasingly being referred to hospice and palliative care. This case series describes a process for evaluating the ongoing need for tracheotomy and the impact of tracheotomy removal. A retrospective cohort design was used in which charts were reviewed of all tracheotomy patients referred to the palliative care unit between November 1, 1998, and July 31, 2001. Tracheotomy was present in 13 of 791 palliative care unit admissions. Persistent airway obstruction contraindicated tracheotomy removal in 5 patients. The remaining patients had a successful "button" trial with subsequent tracheotomy removal. They incurred no complications and exhibited improved functional status and decreased symptom burden. Tracheotomy removal is safe and beneficial in this patient subset and should be considered an alternative to prolonged tracheotomy.

Key Words: tracheotomy prevalence • palliative tracheotomy removal • prolonged mechanical ventilation • tracheotomy complications


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