Clinical Research Directory

Classical Music, Pain, and Physiological Parameters in Children Undergoing Two Aspiration Procedures

Intensive care units (ICUs) are high-technology, high-performance units where patients with life-threatening conditions receive advanced nursing care and continuous monitoring. Pediatric intensive care units (PICUs), a specialized area within ICUs, provide closer observation and treatment than general wards and deliver services in a separate unit. Among the treatments frequently used during PICU stays, children most often receive mechanical ventilation (MV), endotracheal tube, or tracheostomy support because of respiratory diseases and respiratory failure. Endotracheal intubation is the most common means of securing the airway. It is indispensable for airway control in PICUs and is of primary importance for ensuring optimal ventilation and oxygenation. Children receiving MV are exposed to painful stimuli an average of 10-14 times per day, and endotracheal suctioning is one of the most painful procedures for these children. Tracheostomy is a surgical method used to maintain airway patency. Tracheostomy suctioning is part of routine care aimed at preventing infection and obstruction, while also maintaining airway patency. Suctioning is an important nursing intervention in PICU patients with an endotracheal tube or tracheostomy to maintain airway patency and prevent potential infections. Following routine invasive procedures that cause pain, such as suctioning, adverse physiological, metabolic, and behavioral responses may develop in children as stress and the duration and intensity of pain increase. The literature indicates that suctioning causes physiological changes such as pain, restlessness, tachycardia, hypertension, and decreased oxygen saturation, and that these effects are more pronounced in pediatric patients. This necessitates a holistic approach to health that links pain not only to physical conditions but also to psychological and emotional processes. However, the limited doses in which pharmacological analgesics can be used in pediatric patients, the risk of side effects, and the fact that sedation before a procedure is not always possible increase the importance of alternative pain management methods. In this context, nonpharmacological interventions such as listening to classical music can be used both to reduce the pain children experience during procedures and to regulate physiological stress responses. Studies have shown that pain perception decreases, heart rate and respiratory rate are regulated, and anxiety is markedly reduced in children who listen to classical music. The effect of music is based on the stimulation of emotional centers through the limbic system and, through this pathway, the balancing of physiological parameters such as heart rate, blood pressure, and respiration via the autonomic nervous system. Accordingly, this study aims to comparatively examine the effects of classical music played during two different suctioning methods (endotracheal and tracheostomy suctioning) on pain levels and physiological parameters in children receiving care in a pediatric intensive care unit. The limited number of studies on classical music applied during specific, brief invasive procedures such as suctioning underscores the originality of this study and increases its potential to contribute to evidence-based practice in pediatric nursing.

Tracheostomy Practice in Adult Intensive Care Units

ON TRACH is an international, multicentre, observational study with the aim of characterising the timing and practice of tracheostomy insertion, management, weaning and longer-term outcomes of these patients, in intensive care units internationally. Participating intensive care units (ICU) will recruit all consecutive patients undergoing tracheostomy insertion over a 12 week period, aiming for broad global representation. This will allow identification of variation in care of patients with a tracheostomy in the intensive care and it's origin, to drive improvement and enhance safety and outcomes for patients with a tracheostomy in the future.

Evaluation of a Specialised Tracheostomy Team for the Management of Patients With a Tracheostomy Cannula in a Belgium General Hospital: A Retrospective Study.

Patients admitted to intensive care units (ICUs) frequently require prolonged mechanical ventilation. Difficulties in weaning from mechanical ventilation represent an important indication for performing a tracheotomy, which involves creating a temporary opening in the trachea into which a cannula is inserted. This procedure is often confused with a tracheostomy, in which a permanent stoma is created. Tracheotomy offers several clinical benefits, including increased patient comfort, reduced sedation requirements, decreased work of breathing, improved oral hygiene, a lower risk of ventilator-associated pneumonia, and lower mortality. With the increasing use of the percutaneous technique, the procedure is increasingly performed by intensivists. Consequently, the number of patients with a tracheostomy cannula in the ICU is increasing. Following clinical stabilisation, these patients are transferred to inpatient wards throughout the hospital according to their underlying pathology. However, nurses working on these wards encounter tracheostomy-related care less frequently, which may include suctioning, wound care, cannula care, and decannulation. Despite the availability of clinical procedures and protocols, a lack of knowledge, skills, and confidence in providing safe tracheostomy-related care persists. This increases the risk of complications such as cannula obstruction, infection, hypoxaemia, dislodgement, and bleeding. To address this issue, specialised multidisciplinary tracheostomy teams are increasingly being implemented. The aim of this retrospective study is to answer the following research question: What is the impact of a specialised multidisciplinary tracheostomy team on clinical outcomes in hospitalised patients with a tracheostomy cannula?

Impact of a Tracheostomy Team Implementation on Length of Stay and Unplanned Decannulation

The purpose of this study is to evaluate the impact of a specialized tracheostomy team on hospital length of stay (LOS) and unplanned decannulation (UPD) rates in adult tracheostomy patients.