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

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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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


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Newman, A. J. Articles by Bailey, F. A. Search for Related Content PubMed PubMed Citation Articles by Newman, A. J., III Articles by Bailey, F. A. Pubmed/NCBI databases Medline Plus Health Information Palliative Care Social Bookmarking                         What's this?