5 days (P = 0.03) with the median duration of cannulation also reduced from 22.5 to 16.5 days (P = 0.03). These results were both statistically selleckbio significant. The post-TRAMS group reported no adverse events as compared with the two tracheostomy related code-blue calls for the pre-TRAMS group.DiscussionAll papers included in this review came to the conclusion that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU to a general ward setting. Two papers [3,4] also reported that multidisciplinary care reduced the overall length of stay in hospital, as well as the length of stay from ICU discharge. Although these results are encouraging, the historical control design presents a significant potential for bias in all studies.

Studies designed around a historical control are open to bias from many angles. The dissimilarities between the control and treatment group, whether demographic, diagnostic criteria, stage and severity of disease, simultaneous treatments, and differences in observational and data collection conditions, can affect outcomes. Similarly, the time difference between control and intervention groups can introduce differences other than the intervention; for example, change in treatment patterns (eg protocols, guidelines, and changes in staffing) and other exposures that are unknown to data collectors or not recorded in medical records. All of these variables have the potential to affect the results of the studies appraised.

Multidisciplinary care is a complex intervention that is difficult to evaluate due to its multiple and varying components. All appraised studies presented different descriptions of multidisciplinary care including different collaborations of disciplines. Therefore, it is difficult to infer the combination of disciplines that should make up the most appropriate multidisciplinary care team for tracheostomy patients.It should be noted that in these studies [2-4] the multidisciplinary teams were led by different specialists: an intensivist, an ENT specialist and a respiratory physician, respectively. This is important because it may limit the generalisability of multidisciplinary teams for tracheostomy Brefeldin_A care as we are unable to tell whether the effects reported were due to the dedicated ‘tracheostomy’ feature, the multidisciplinary nature of the care or the medical and specialist nature of the leadership.Multidisciplinary tracheostomy teams are now widespread in national and international health services and are seen to be the most appropriate model of care for tracheostomy patients [2-7].