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Title: The medical management of saliva in tracheostomised patients : a case series
Author: Vyas, C.
ISNI:       0000 0004 8498 144X
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2016
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Background: Saliva is a common problem in tracheostomised patients, whereby saliva is spilled through the faucial isthmus creating risk of aspiration. These individuals are dependent on tracheal suctioning to clear saliva from the airway. There is currently no evidence about the relative effectiveness of any of the pharmacological treatments to manage saliva in this patient population. Methods and procedures: This prospective interrupted time series study investigated the medical management of saliva in tracheostomised patients. Three inpatients at The Wellington Hospital London were enrolled, prescribed treatment using Hyoscine (Scopoderm® TTS). Unstimulated whole saliva was collected, using the swab method, at one-week prior, one-week, two-weeks, four-weeks, eight-weeks and at 12 weeks post treatment. The primary outcome measure was dental roll weights measured at these time-points. Primary carer and nursing reports in relation to the amount of oral secretions and tracheostomy self-perceptions were also recorded at these same time intervals, using a visual analogue scale and a questionnaire. The frequency and reasoning of tracheal suctioning was also recorded, by the same nurse at these time-points. Data was analysed using linear regression for oral secretions and a Chi-Square test was performed for frequency of tracheal suctioning. Outcomes and results: There was a significant reduction in oral secretions post treatment intervention, F= 27.252, df= 1, 52; p < 0.001, F=11.62, df=1, 52, p < 0.001, F=159.314, df=1, 52, p < 0.001. There was a significant reduction in the frequency of tracheal suctioning performed post intervention, Fisher's Exact Test p=0.094; with the primary reason recorded as audible or visible secretions. All primary caregivers and the same one-to-one nurse reported that oral secretions had reduced. Conclusion and implications: The medical management of saliva in tracheostomised patients, using Hyoscine (Scopoderm® TTS) was effective in reducing saliva and tracheal suctioning. This study suggests that further research is required in order to establish clinical practice guidelines in the use of Hyoscine (Scopoderm® TTS) in this patient population.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available