Figure 1Number of studies included. Key reasons for exclusion: 1 = not a comparative study; 2 = irrelevant setting; 3 = irrelevant Erlotinib intervention; 4 = irrelevant comparator; 5 = irrelevant outcomes. Search flow chart: n = number of studies.Three relevant studies were identified that met the study selection criteria. All were cohort studies with historical controls [2-4]. Critical appraisals of the quality of the three cohort studies are available [See additional data file 1].All studies included adult patients with tracheostomies. One study was conducted in the UK [2] and the other two in Australia [3,4].Study resultsThe first study was a historical cohort study including patients with a tracheostomy discharged from an intensive treatment unit (ITU) to a general ward at St.
Mary’s Hospital, Paddington, London, UK. A total of 89 patients were included, of which 79 were the control group and 10 received the intervention. The intervention included a weekly Tracheostomy Multidisciplinary Team (TMDT) ward round (TMDT members included an ear nose and throat Specialist Registrar (ENT SpR) and Specialist Trainee Year 2 (ST2), speech and language therapist, respiratory physiotherapist and a critical care outreach nurse), monthly teaching sessions organised for nursing staff involved with tracheostomy care and an ENT-led training day for physiotherapists and speech and language therapists. This intervention was compared retrospectively with standard care.
The study looked at the impact of the intervention on the following outcomes: time to tracheostomy tube decannulation post-ITU discharge, total time of tracheostomy (not defined, but we can presume the definition of total time is inclusive of ITU and general ward stay) and compliance with local tracheostomy care guidelines (St. Mary’s tracheostomy care bundle) between the intervention group and a group of 70 patients of whom little information is provided for selection criteria (this outcome was therefore excluded from the appraisal of this paper).The methods of this study were not well documented. Overall we found the risk of bias in this study to be high. Inclusion and exclusion criteria were not clearly documented; group similarity was not achieved (eg 10-year mean age difference); measurement of exposure and outcomes was not standardised, valid or reliable; and there was some uncertainty about the percentage lost to follow up.
Contributing to the high risk of bias is the historical control study design. A historical control produces opportunities for bias, which can arise from the dissimilarity between control and treatment groups, differences between the hospital Entinostat environment at the time of the intervention and earlier conditions at the time of the historical control and the difficulty in controlling for confounding.