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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4773_Библиотеки_им_академика_М_И_Перельмана.pdf
NTSP Editorial board
Dr Brendan McGrath
Consultant in Anaesthesia & Intensive Care Medicine, University
Hospital of South Manchester;
Honorary Senior Lecturer, University of Manchester and University
of Salford
Dr Dougal Atkinson
Consultant in Anaesthesia & Intensive Care Medicine, Central
Manchester Foundation Trust
Dr John Moore
Consultant in Anaesthesia & Intensive Care Medicine, Central
Manchester Foundation Trust
Dr Lucy Bates
Consultant in Anaesthesia & Intensive Care Medicine, Royal
Bolton Hospital
Dr Carl Gwinnutt
Resus Council (UK)
Sr Sam Westwell
Critical Care Nurse Consultant, Salford Royal Hospital
Dr Anna Perks
Consultant Anaesthetist, Salford Royal Hospital
Mr Nick Calder
Consultant ENT surgeon, NHS Lanarkshire
CN Tim Baker
ICU Nurse Practitioner, University Hospital of South Manchester
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Mr Alan Jervis
Resuscitation Training Officer, Salford Royal Hospital
Mrs Sarah Wallace
Speech and Language Therapist, University Hospital of South
Manchester & Royal College of Speech & Language Therapists
Ms Barbara Bonvento
Physiotherapist, University Hospital of South Manchester
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Preface
This manual is a resource developed by the UK NTSP to help promote
and facilitate the safe management of tracheostomies and laryngectomies.
The scope includes hospital in-patient specialist areas, such as critical
care, head and neck units and specialist wards, but is also applicable to
more general wards, outpatient and community settings. The majority of
the content is for adult patients, with a new paediatric chapter developed
with colleagues from Great Ormond Street Hospital.
We have attempted to make the resource a ‘one-stop shop’ covering all
aspects of tracheostomy and laryngectomy management by collecting
together resources from surgical, anaesthetic, nursing, intensive care and
allied health backgrounds, along with guidance from key national
stakeholder organisations. These include the Difficult Airway Society,
Intensive Care Society, the Royal College of Anaesthetists, ENT UK,
British Association of Oral and Maxillofacial Surgeons, College of
Emergency Medicine, Resuscitation Council UK, Royal College of
Nursing, Royal College of Speech and Language Therapists, Association
of Chartered Physiotherapists in Respiratory Care, British Laryngological
Association, Faculty of Intensive Care Medicine, National Association of
Laryngectomy Clubs and the National Patient Safety Agency.
We have also reviewed many local, regional, national and international
guidelines, policies and resources during the preparation of this manual.
Many such groups have previously developed excellent resources for the
care of ‘neck breathers’, but these were often focused on specific areas of
practice. We have also received many hundreds of comments on draft
resources and further advice from around the world. We are grateful to the
many individuals who have contributed to this project in this way and
have acknowledged as many as possible where appropriate.
This unique document has been developed by consulting as widely as
possible, across traditional professional boundaries using expertise and
existing guidance from around the world. The manual attempts to pull
together the different pieces of the jigsaw that already existed, as well as
devising new resources where we felt they were needed. Previous work is
referenced and accredited where appropriate, and we are grateful for the
permissions that have been granted for use of other materials. This manual
is supported by our website www.tracheostomy.org.uk, which contains
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many new educational resources, e-learning packages and videos. We
have included urls in the footnotes, where relevant, to the specific sections
of the website and our resources.
This guidance is applicable for a novice first responder looking after a
patient with a tracheostomy or laryngectomy for the first time, through to
an airway expert secondary responder.
We hope you find these resources useful. Please contact us if you have
any further comments or resources that you feel would add to this project.
We are particularly interested to hear if the emergency algorithms have
been used successfully.
Dr Brendan McGrath
Consultant in Anaesthesia & Intensive Care Medicine
University Hospital of South Manchester
Manchester, UK
Honorary Senior Lecturer
University of Manchester
University of Salford
On behalf of the Working Party of the National Tracheostomy Safety
Project
www.tracheostomy.org.uk
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Acknowledgements
This project would not have been possible without the valued time and
contributions of a great many people. We have endeavoured to list as
many as we can in this section. We have also been granted permission to
use images, documents, videos and resources from many sources.
We are indebted to the following organisations and individuals for
comments and advice on early versions of the manuscript and algorithms,
and for their input into the wider resources and remit of the project:
Difficult Airway Society: Dr Ellen O'Sullivan (President); Dr Atul
Kapilla (Secretary); Prof Jaideep Pandit (Scientific Officer); Dr
Peter Groom (Treasurer) and Dr Andy Higgs
Royal College of Anaesthetists: Dr Peter Nightingale (President)
and Dr Tim Cook (NAP advisor to the RCoA)
Intensive Care Society: Dr Simon Baudouin (Standards
Committee chair); Dr Andrew Bodenham (ICS Tracheostomy
Standards Author) and Dr Andrew Bentley (Council member) Also:
Simon Mackenzie; Paul Murphy, Dominic Bell; Steve Bonner;
Fiona Branch; Deborah Dawson; Paul Morgan; Simon Baudouin
and Kevin Gunning
ENT UK: Mr Andrew McCombe (Honorary Secretary); Mr Vinidh
Paleri; Mr Paul Pracy and Mr Richard Wight (Head and Neck
Committee)
BAOMS: Prof Simon Rogers (Chair, Clinical Effectiveness
Committee)
RCSLT: Mrs Sarah Wallace and Mrs Susan McGowan (Expert
Advisors)
CSP: Mrs Cathy Sandsund (ACPRC Research Officer) and Mr
David McWilliams (ACPRC Critical Care Champion)
RCN: Sr Rachel Binks (Chair, Critical Care Steering Committee)
CEM: Prof Jonathan Benger (Chair, Clinical Effectiveness
Committee and Emergency Airway Lead)
NPSA: Mrs Joan Russell (Head of Patient Safety Anaesthesia and
Surgery) and Mrs Fran Watts (Patient Safety Lead, Surgery)
Resuscitation Council UK: Dr Carl Gwinnutt; Dr Jerry Nolan and
Dr Jasmeet Soar (on behalf of the Executive Committee)
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British Association of Laryngology: Prof Martin Birchall and Mr
Taran Tatla
With thanks to all Working Party members and contributors, especially:
Sr Sam Westwell, Nurse Consultant Critical Care, Salford Royal
Hospitals FT
Dr Anna Perks, Consultant Anaesthetist, Salford Royal Hospitals
FT
Dr Jane Eddleston, Consultant Intensivist, Central Manchester FT
Dr Bernard Foex, Consultant Intensivist, Central Manchester FT
Dr Irfan Chaudry, Consultant Intensivist, Royal Preston Hospital
Dr Ben Slater, Consultant in Anaesthesia & ICM, NHS Fife,
Edinburgh
Sr Elaine Grainger, Critical Care Outreach, UHSM
CN Tim Baker, AICU Practice Educator, UHSM
Sr Jo Cooke, Tracheostomy Nurse Specialist, GOSH
Miss Michelle Wyatt, Consultant Paediatric ENT surgeon, GOSH
Dr Carl Gwinnutt, Resus Council UK
Dr Cath Roberts, Consultant in Emergency Medicine, Royal Preston
Hospital
Dr Claire Moore, Consultant in Anaesthesia, UHSM
Dr Dan Nethercott, Consultant in Anaesthesia and ICM, Blackburn
Dr Harry Chan, Consultant in Anaesthesia and ICM, Wigan
Sr Helen Slattery, UHSM
Dr Iain Gall, Consultant in Anaesthesia, Central Manchester FT
Dr Jon Arnot Smith, Consultant Intensivist, Royal Bolton
NPSA expert reference group:
Prof Anthony Cheeseman (The Wellington Hospital, London)
Dr William Oldfield (Imperial College, London)
Prof Anthony Narula (St Mary's Hospital, London)
Mr Khalid Ghufoor (The Royal London Hospital)
Mr Guri Sandhu (Imperial College, London)
Mr Asit Arora (St Mary's Hospital, London)
Mrs Claudia Russell (Cambridge)
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Lindsay Benjamin (St Mary's Hospital, London)
With thanks also to:
Mr Alan Ryan, National Programme Director, Heath Education
England e-Learning for Healthcare (HEE e-LfH) for permission to
use graphics and images developed with e-LfH, used in this manual.
Mr Nick Cleary, eLfH, for assistance with images and artwork,
especially for the eLfH e-learning resources.
Mr Dev Chandramani & Mr Deepak Sharma from Boxsail for
Website and SmartPhone App design. http://www.boxsail.co.uk
Special thanks to Emma McGrath, Ali Atkinson, Claire Moore,
Damian Bates and all of our extended families for the support and
assistance, childcare and facilitating all of the late nights that have
made this project possible.
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Competing interests
The NTSP has received funding from the Intensive Care Society (ICS)
and assistance from the Royal College of Anaesthetists (RCoA) (allowed
use of in-house programmers) specifically to contribute towards the
e-learning for healthcare modules developed as part of this project.
The project has also received sponsorship from the following companies:
Smiths-Medical (Portex), Cook, Kapitex, Ambu a-Scope, Olympus,
Astellas Pharma and Pfizer. This sponsorship has specifically been used to
reduce the cost of medical, nursing and allied health staff attending our
tracheostomy safety courses and has not influenced the production or
development of these resources. No individual or organisation has
benefitted financially from this project.
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Disclaimer
While this information has been collected and designed to help in clinical
management, the authors do not accept any responsibility for any harm,
loss or damage arising from actions or decisions based on the information
contained within this publication, the associated website and materials.
Ultimate responsibility for the treatment of patients and interpretation of
these materials lies with the medical practitioner/user. The opinions
expressed are those of the authors. The inclusion in this publication of
material relating to a particular product or method does not amount to an
endorsement of its value, quality or the claims made by its manufacturer.
These guidelines should not constitute a minimum standard of practice nor
should they be regarded as a substitute for good clinical judgement.
Every effort has been made by the authors to use materials and sources
that are reliable and provide information that is compatible with the
standards generally accepted at the time of publication. Because of the
nature of medical practice, we recommend that the reader always consults
current research and institutional policies before performing clinical
procedures. The authors accept no responsibility for the persistence or
accuracy of urls for external content referred to in this publication.
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Contact details and further information
NTSP: www.tracheostomy.org.uk
ALSG: www.alsg.org
For details on ALSG courses, visit the website or contact:
Advanced Life Support Group
ALSG Centre for Training and Development
29-31 Ellesmere Street
Swinton, Manchester
M27 0LA
Tel +44 (0) 161 794 1999
Fax +44 (0) 161 794 9111
Email: enquiries@alsg.org
Updates
The material within this book will be updated on a 5-yearly cycle.
However, practice and advice may change in the interim period. We will
post any changes on the ALSG website, so we advise that you visit the
website regularly to check for updates (www.alsg.org—go to the
Tracheostomy page). The website will provide you with a new page to
download and replace the existing page in your book.
Permission granted to reproduce for personal and educational use only.
Commercial copying, hiring, lending or sale is prohibited.
The NTSP is acknowledged as the author of this manual.
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