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This article is part of the supplement: 33rd International Symposium on Intensive Care and Emergency Medicine

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Evidence-based guidelines and protocols for the management of adult patients with a tracheostomy: a systematic review

J Siddiqui1*, PB Sherren2 and MA Birchall3

  • * Corresponding author: J Siddiqui

Author Affiliations

1 North West London Hospitals NHS Trust, London, UK

2 Barts and The London NHS Trust, London, UK

3 The Royal National Throat Nose and Ear Hospital, London, UK

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Critical Care 2013, 17(Suppl 2):P166  doi:10.1186/cc12104

The electronic version of this article is the complete one and can be found online at:

Published:19 March 2013

© 2013 Siddiqui et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Protocol-based care of the tracheostomised patient is important, as adverse events confer a high rate of mortality. Little is known regarding the existence of formal evidence-based guidelines on tracheostomy care. The aim of this study was to perform a systematic review for evidence-based guidelines on adult tracheostomy care.


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 was performed. Search terms: (tracheostom* OR tracheotom*) AND (protocol* OR guideline* OR standard* OR management OR consensus OR algorithm*). Filters: English language, human, from 1 January 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 [1].


The search results are summarised in Table 1. A total of 80 guidelines were identified. Five were found to satisfy the AGREE II criteria and only three related to the entire spectrum of tracheostomy management. The majority was informal and was not published or evidence based.

Table 1. Summary of results returned following systematic review


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. This also highlights the need for international consensus on the topic, to reduce duplication of efforts, standardise practice, and improve outcomes.


  1. Appraisal of Guidelines for Research and Evaluation: Instrument. AGREE II [] webcite