Redesigning Post-Tracheostomy Care: A Multidisciplinary Model for Trauma Critical Care Patients

Introduction: Tracheostomy management in trauma patients presents unique challenges, often resulting in delayed decannulation, prolonged ICU length of stay (LOS), and fragmented discharge planning. While global initiatives such as the Global Tracheostomy Collaborative advocate for multidisciplinary approaches, trauma-specific integration remains underutilized. This initiative introduces a trauma-focused multidisciplinary tracheostomy team designed to streamline care, improve patient trajectories from tracheostomy, and minimize adverse events.


Methods: A prospective cross-sectional study was conducted from October 2024 to June 2025, evaluating trauma patients who underwent tracheostomy at a large level 1 Trauma Center. Intervention involved a dedicated multidisciplinary ICU team—trauma surgeon, advanced practice providers, speech-language pathologists (SLP), respiratory therapists, and critical care nurses—engaged from tracheostomy placement through discharge. Outcomes included time SLP evaluation post-tracheostomy, initiation of in-line Passy Muir valve (PMV), time to initiation of oral diet, rate of decannulation, and ICU LOS. Descriptive statistics were used for analysis.


Results: Forty-four trauma patients requiring tracheostomy were analyzed. The pre-implementation cohort (n=20) had a mean age of 38 years and an average Injury Severity Score (ISS) of 26, while the post-implementation cohort (n=24) had a mean age of 50 years and an ISS of 30.

Post-implementation, time to SLP evaluation decreased from 12 to 7 days, in-line Passy-Muir Valve use increased from 5% to 36%, and time to oral intake was reduced from 29 to 24 days. Decannulation prior to discharge rose from 30% to 44%.

Despite these improvements, overall hospital LOS increased from 34.2 to 41.3 days, and ICU LOS from 27.6 to 30.4 days, likely attributable to the increased injury severity in the post-implementation group.


Conclusions: This trauma-specific multidisciplinary tracheostomy model demonstrates early success in optimizing critical care pathways. By fostering coordinated, specialty-driven care, this initiative shows promise in reducing ICU delirium, early decannulation, and other adverse outcomes. These findings support broader adoption and further investigation of integrated tracheostomy care in trauma populations.