Petroleum Jelly vs. Saline in Tracheostomy Wound Care and Ulcer Prevention: A Randomized Controlled Trial

Petroleum Jelly vs. Saline in Tracheostomy Wound Care and Ulcer Prevention: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Petroleum Jelly vs. Saline in Tracheostomy Wound Care and Ulcer Prevention: A Randomized Controlled Trial Chidchanok Chutimasaengtrakul, Sarinya Urathamakul, Kanokrat Bunnag This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6396685/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted 17 You are reading this latest preprint version Abstract Purpose: This study aimed to compare the efficacy of petroleum jelly application and sodium chloride irrigation in preventing pressure ulcers and promoting tracheostomy wound healing. Trial registration: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. (https://www.thaiclinicaltrials.org/show/TCTR20240806002) Study Design : Prospective randomized controlled trial Setting : Tertiary referral center, a university-based hospital Methods: This study enrolled 28 participants, aged 18–80 years, who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University. They were randomly assigned using a block of four randomization methods to either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group. The outcomes were evaluated by one physician and one nurse at 1, 2, and 4 weeks postoperatively using the Pressure Ulcer Scale for Healing (PUSH) Tool and Skin Integrity Score. Results: The petroleum jelly application group demonstrated significantly lower mean scores on the PUSH Tool at 1, 2, and 4 weeks than the sodium chloride irrigation group. Moreover, the petroleum jelly application group exhibited significantly higher median scores for skin integrity at 1, 2, and 4 weeks than the sodium chloride irrigation group. The interrater reliability between the two assessors was good to excellent. Conclusions: The participants who received petroleum jelly application following tracheostomy demonstrated better results in preventing pressure ulcers and maintaining skin integrity compared with those who received sodium chloride irrigation. tracheostomy petroleum jelly the Pressure Ulcer Scale for Healing (PUSH Tool) Skin Integrity Score Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Tracheostomy,( 1 – 3 ) a surgical procedure, establishes a direct passage between the trachea and the anterior neck skin, serving various purposes, such as managing upper airway obstructions and addressing conditions, such as severe obstructive sleep apnea, prolonged mechanical ventilation, and laryngeal or head and neck cancer. Regular post tracheostomy monitoring is crucial to assess patients’ conditions and replace the tracheostomy tube as needed, with complications including bleeding, tube obstruction, pressure ulcers, and wound infections. Pressure ulcers( 4 ) represent a significant concern following tracheostomy. Preventive measures entail meticulous wound care,( 5 , 6 ) which includes cleansing the skin around the tube with saline-soaked gauze or cotton and positioning gauze under the tube to prevent direct contact between the tube and skin. This approach not only improves patients’ quality of life but also accelerates hospital discharge, leading to shorter hospital stays. This study aimed to compare the efficacy of petroleum jelly application and sodium chloride irrigation in preventing pressure ulcers and promoting tracheostomy wound healing, with the ultimate goal of improving patients’ quality of life and accelerating hospital discharge, thereby leading to shorter hospital stays. Materials and Methods A prospective randomized controlled trial, approved by the Research Ethics Review Committee (IRB no: 163/64FB), included 28 participants aged 18–80 years who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University, between November 2021 and December 2022. The exclusion criteria included tracheostomy procedures in patients with coronavirus disease 2019, emergency tracheostomy procedures, and tracheostomy procedures involving neck surgery or neck masses. The discontinuation criteria included death or the inability to care for the tracheostomy wound by dressing alone, such as requiring surgical debridement. Clinical trial number: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. This study adheres to the CONSORT guidelines for the reporting of randomized controlled trials. No interim analyses or early stopping guidelines were planned for this trial. The sample size( 7 – 9 ) was determined using the following formula for randomized control trials: $$\:{n}_{trt\:}=\frac{{{(z}_{1-\frac{\alpha\:}{2}}+{z}_{1-\beta\:})}^{2}\left[{{\sigma\:}_{trt}}^{2}\right.+\frac{{{\sigma\:}_{con}}^{2}}{r}]}{{\varDelta\:}^{2}}$$ σ trt 2 = a standard deviation in treatment group σ con 2 = a standard deviation in control group r = Ratio (control/treatment) = 1 α = 0.05, Z(0.95) = 1.96 β = 0.20, Z(0.80) = 0.84 Sample size: treatments = 11, controls = 11 After using a continuity correction, the sample size of each group was 14 participants. The participants were randomized using a block of four randomization methods into either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group to compare their efficacy in preventing pressure ulcers and promoting tracheostomy wound healing. The random allocation sequence was generated by a statistician independent of the trial and was concealed using sealed, opaque, sequentially numbered envelopes. These envelopes were opened by the otolaryngology resident only after the participant's enrollment and baseline assessment, ensuring that the allocation remained concealed until the intervention was assigned. Wound care after a tracheotomy begins the day following the procedure. For the saline group, wounds are cleaned with saline solution and then covered with gauze. In the petroleum jelly group, wounds are cleaned similarly with saline, followed by the application of 0.5 grams of petroleum jelly around the wound edges, and then covered with gauze. Both groups receive daily care from trained otolaryngology residents or nurses, with caregivers continuing the care at home. The outcomes were assessed by one physician and one nurse at 1, 2, and 4 weeks postoperatively using the Pressure Ulcer Scale for Healing( 10 , 11 ) (PUSH) Tool and Skin Integrity Score.( 12 ) (Fig. 1) (Fig. 2) Importantly, the outcome assessors were blinded to the group assignments to minimize bias in the evaluation of wound healing. Statistical analysis Continuous data are presented as means and standard deviations if the data were normally distributed. Otherwise, they are presented as medians (with ranges). The corresponding significance tests were conducted using an independent t-test or the Mann–Whitney U test. Categorical data are presented as frequencies and percentages and were compared using Fisher’s exact test. Interrater reliability was assessed using the Intraclass Correlation Coefficient. All analyses were performed using SPSS version 26.0, with p -values < 0.05 denoting statistical significance. No subgroup or ancillary analyses were performed. Results General Characteristics The 28 patients who underwent tracheostomy procedures were randomly assigned to two groups. Fourteen patients used petroleum jelly for dressing their wounds, whereas the other 14 patients used sodium chloride irrigation (0.9% NaCl solution) for dressing their wounds. The study found no differences in basic demographic information. In the petroleum jelly application group, seven were female patients and seven were male patients, with an average age of 65.07 ± 8.38 years. In the sodium chloride irrigation group, four were female patients and 10 were male patients, with an average age of 66.29 ± 12.94 years. No significant differences in other demographic characteristics were observed between the two groups, including height, weight, body mass index, hemoglobin, hematocrit, serum albumin, serum creatinine, aspartate aminotransferase, alanine aminotransferase, diabetes mellitus, smoking history, and history of infection, including sepsis, pneumonia, and other infections. (Table 1 ) Table 1 Characteristic of patients Characteristic Petroleum jelly (n = 14) Control (n = 14) P-value Age (year) 66.29 ± 12.94 65.07 ± 8.38 0.771 c Sex 0.246 a Female 7 (50.00) 4 (28.57) Male 7 (50.00) 10 (71.43) Height (cm.) 158.43 ± 6.12 160.93 ± 6.90 0.320 c Weight (kg.) 54.18 ± 7.64 55.14 ± 14.22 0.825 c BMI ( kg/cm 2 ) 21.97 ± 3.69 21.42 ± 5.17 0.746 c Hb (mg/dl) 10.69 ± 2.28 10.54 ± 1.68 0.837 c Hct (%) 31.46 ± 6.96 32.26 ± 5.82 0.744 c Serum Albumin (g/dl) 2.96 ± 0.70 3.06 ± 0.73 0.694 c Serum Creatinine (mg/dl) 0.84 (0.55–4.24) 0.83 (0.33–4.9) 0.927 d AST (U/l) 41.5 (19–150) 32 (12–170) 0.629 d ALT ( U/l) 20 (6–78) 18.5 (5–97) 0.597 d Diabetic mellitus (%) 0.699 a No 8 (57.14) 9 (64.29) Yes 6 (42.86) 5 (35.71) Smoking (%) 0.256 a No 8 (57.14) 5 (35.71) Yes 6 (42.86) 9 (64.29) Characteristic Petroleum jelly (n = 14) Control (n = 14) P-value History of infection (%) - Sepsis 0.445 a No 7 (50.00) 9 (64.29) Yes 7 (50.00) 5 (35.71) - Pneumonia 0.058 a No 5 (35.71) 10 (71.43) Yes 9 (64.29) 4 (28.57) - Other 1.000 b No 12 (85.71) 11 (78.57) Yes 2 (14.29) 3 (21.43) Data are presented as number (%), mean ± standard deviation or median (interquartile range) a P-value from Chi-square test b P-value from Fisher’s exact test c P-value from Independent samples t-test d P-value from Mann-Whitney U test PUSH Tool Tracheostomy wound healing was compared between the two groups using the PUSH( 10 , 11 ) Tool) at weeks 1, 2, and 4 postoperatively, evaluated by one physician and one nurse. (Table 2 ) (Fig. 3) The study results from physician assessments showed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (8.93 ± 1.59 in the petroleum jelly application group vs. 10.21 ± 1.25 in the control group, p = 0.025), 2 (7.43 ± 1.45 in the petroleum jelly application group vs. 9.00 ± 1.30 in the control group, p = 0.006), and 4 (6.79 ± 1.58 in the petroleum jelly application group vs. 8.29 ± 1.20 in the control group, p = 0.009). The study findings from nurse assessments revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (9.00 ± 1.66 in the petroleum jelly application group vs. 10.64 ± 1.08 in the control group, p = 0.005), 2 (7.79 ± 1.53 in the petroleum jelly application group vs. 9.64 ± 1.15 in the control group, p = 0.001), and 4 (7.14 ± 1.51 in the petroleum jelly application group vs. 9.00 ± 0.96 in the control group, p = 0.001). The combined assessment results from the physician and nurse showed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (8.96 ± 1.61 in the petroleum jelly application group vs. 10.43 ± 1.11 in the control group, p = 0.009), 2 (7.61 ± 1.44 in the petroleum jelly application group vs. 9.32 ± 1.14 in the control group, p = 0.002), and 4 (6.96 ± 1.51 in the petroleum jelly application group vs. 8.64 ± 0.97 in the control group, p = 0.002). From the assessment of wound healing scores using the PUSH Tool, it was found that the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistical significance in the assessments conducted by both the physician and nurse and in the combined assessments by the physician and nurse. Table 2 The Pressure Ulcer Scale for Healing (PUSH Tool) The Pressure Ulcer Scale for Healing (PUSH Tool) Petroleum Jelly (n = 14) Mean ± SD Control (n = 14) Mean ± SD P-value Evaluated by physician week 1 8.93 ± 1.59 10.21 ± 1.25 0.025 week 2 7.43 ± 1.45 9.00 ± 1.30 0.006 week 4 6.79 ± 1.58 8.29 ± 1.20 0.009 Evaluated by nurse week 1 9.00 ± 1.66 10.64 ± 1.08 0.005 week 2 7.79 ± 1.53 9.64 ± 1.15 0.001 week 4 7.14 ± 1.51 9.00 ± 0.96 0.001 Evaluated by physician and nurse week 1 8.96 ± 1.61 10.43 ± 1.11 0.009 week 2 7.61 ± 1.44 9.32 ± 1.14 0.002 week 4 6.96 ± 1.51 8.64 ± 0.97 0.002 Data are presented as mean ± standard deviation p-value from Independent t-test Skin Integrity Score Skin integrity( 12 ) of tracheostomy wounds after surgery was compared between the two groups, assessed by one physician and one nurse each, using the Skin Integrity Score at weeks 1, 2, and 4. (Table 3 ) (Fig. 4) The study findings from physician assessments revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (median = 5 in the petroleum jelly application group vs. 2 in the control group, p = 0.002), 2 (median = 6 in the petroleum jelly application group vs. 5 in the control group, p = 0.003), and 4 (median = 6.5 in the petroleum jelly application group vs. 5 in the control group, p = 0.010). The study findings from nurse assessments revealed that at weeks 1 and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation, with statistically significant differences at weeks 1 (median = 4 in the petroleum jelly application group vs. 3 in the control group, p = 0.009) and 4 (median = 6 in the petroleum jelly application group vs. 5 in the control group, p = 0.012). However, in week 2, the scores showed no statistically significant difference (median = 6 in the petroleum jelly application group vs. 5 in the control group, p = 0.237). The combined assessment results from the physician and nurse revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (median = 4.5 in the petroleum jelly application group vs. 2.5 in the control group, p = 0.005), 2 (median = 6 in the petroleum jelly application group vs. 5 in the control group, p = 0.016), and 4 (median = 6.25 in the petroleum jelly application group vs. 4.75 in the control group, p = 0.010). From the assessment of skin integrity scores for tracheostomy wounds, it was found that the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistical significance in assessments conducted by both the physician and nurse and in the combined assessments by the physician and nurse. Table 3 Skin integrity score Skin Integrity score Petroleum Jelly (n = 14) Median (min-max) Control (n = 14) Median (min-max) P-value Evaluated by physician week 1 5 ( 2 – 7 ) 2 ( 2 – 5 ) 0.002 week 2 6 ( 5 – 7 ) 5 ( 2 – 7 ) 0.003 week 4 6.5 ( 5 – 7 ) 5 ( 2 – 7 ) 0.010 Evaluated by nurse week 1 4 ( 2 – 7 ) 3 ( 2 – 6 ) 0.009 week 2 6 ( 3 – 7 ) 5 ( 2 – 7 ) 0.237 week 4 6 ( 4 – 7 ) 5 ( 2 – 7 ) 0.012 Evaluated by physician and nurse week 1 4.5 ( 2 – 7 ) 2.5 (2–5.5) 0.005 week 2 6 ( 4 – 7 ) 5 ( 2 – 7 ) 0.016 week 4 6.25 (4.5–7) 4.75 ( 2 – 7 ) 0.010 Data are presented as median (interquartile range) p-value from Mann-Whitney U test Interrater reliability The interrater reliability assessments using the ICC( 13 ) for the PUSH Tool at weeks 1, 2, and 4 were 0.957 (95% confidence interval [CI]: 0.906–0.980, p < 0.001), 0.926 (95% CI: 0.841–0.966, p < 0.001), and 0.923 (95% CI: 0.834–0.964, p < 0.001), respectively. The interrater reliability assessments using the ICC( 13 ) for the Skin integrity Score at weeks 1, 2, and 4 were 0.947 (95% CI: 0.886–0.976, p < 0.001), 0.848 (95% CI: 0.671–0.930, p < 0.001), and 0.970 (95% CI: 0.935–0.986, p < 0.001), respectively. From the assessment results, there was a high level of agreement among the assessors, which was statistically significant. The reliability between assessors fell within the range of 0.75–1.00, indicating good to excellent agreement among them. (Table 4 ) No adverse events or unintended effects were reported in either group during the study period. Table 4 Inter-rater reliability Inter-rater reliability ICC 95% Confidence Interval p-value Lower Upper PUSH Tool week 1 0.957 0.906 0.980 < 0.001 week 2 0.926 0.841 0.966 < 0.001 week 4 0.923 0.834 0.964 < 0.001 Skin Integrity score week 1 0.947 0.886 0.976 < 0.001 week 2 0.848 0.671 0.930 < 0.001 week 4 0.970 0.935 0.986 < 0.001 ICC = Intraclass Correlation Coefficient Discussion Pressure ulcers and wound healing following tracheostomy procedures present a significant concern and impacts the quality of life of patients. In Thailand, accessing moisture-retentive dressings, such as Mepilex Ag,( 14 ) foam dressings,( 15 , 16 ) Drain sponge,( 17 ) and solid skin barriers, is challenging because of their high cost and the requirement for daily changes. Meng Yue et al.( 18 ) found that moisture-retentive wound dressings can better prevent and reduce the occurrence of pressure ulcers. Petroleum jelly( 19 , 20 ) is one such moisture-retentive substance with properties that prevent water loss and increase skin moisture, aiding in moisture retention and reducing the occurrence of pressure ulcers. Furthermore, it is easy to use; is cost-effective; has specific properties, such as nonabsorption into the bloodstream; is suitable for most skin types; has a nonirritating nature; and has efficacy comparable to that of other moisture-retentive wound dressings. Therefore, it is being used in this research project. The population included in this study primarily comprised males aged between 18 and 80 years who underwent tracheostomy procedures. According to the study findings, petroleum jelly was effective in preventing pressure ulcers and promoting wound healing, as assessed by the PUSH( 10 , 11 ) Tool and Skin Integrity( 12 ) Score. These assessments revealed statistically significant improvements compared with normal saline solution. The consistency of assessment results between the physician and nurse, along with statistically significant interrater reliability, further supports the effectiveness of petroleum jelly. Each participant underwent a medical history review and physical examination, which was conducted by a single physician (the researcher). This approach was employed to minimize potential discrepancies that could arise from multiple examiners. The purpose of these procedures was to accurately classify the target groups and to explain the utilization of tools, wound care procedures, and data collection methods. From this study, it was observed that the use of petroleum jelly was effective in preventing pressure ulcers and facilitating wound healing in patients undergoing tracheostomy procedures. The results are consistent with those of Meng Yue et al.,( 18 ) who found that wound care using moist dressings can prevent and reduce the occurrence of pressure ulcers. The limitations of this study include its small sample size, which may not fully reflect the diversity of the population undergoing tracheostomy procedures. Furthermore, having only two evaluators could introduce potential biases in the assessments because different evaluators may have varying perspectives and interpretations. Moreover, the study only experimented with one type of petroleum jelly, particularly the product from the hospital’s production. This limitation restricts the generalizability of the findings to other types of petroleum jelly products available in the market. To address these limitations and further develop the research, the researchers suggest increasing the sample size to enhance the representativeness of the findings. Expanding the number of evaluators, including both physicians and nurses, can provide a more comprehensive assessment and reduce potential biases. Furthermore, future studies could explore the efficacy of different materials and compare them with petroleum jelly to determine the most effective option for preventing pressure ulcers and facilitating wound healing in patients undergoing tracheostomy. Conclusion Participants who received petroleum jelly application following tracheostomy exhibited better results in preventing pressure ulcers and maintaining skin integrity than those who received sodium chloride irrigation. Abbreviations PUSH Tool the Pressure Ulcer Scale for Healing Tool Declarations Ethics approval and consent to participate This study adhered to the principles outlined in the Declaration of Helsinki. Approval was granted by the Research Ethics Review Committee of the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand (approval number: 163/64FB). Trial registration: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. (https://www.thaiclinicaltrials.org/show/TCTR20240806002) All participants or their legal guardians provided written informed consent prior to enrollment in the study. Consent for publication Not applicable. Availability of data and materials The full trial protocol or the datasets used and/or analyzed in this present study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding The authors have no funding, financial relationships, or conflicts of interest to disclose. Authors’ contribution CC: conceptualization, methodology, data collection, data analysis, draft writing and final approval of the version to be published. SU: conceptualization, methodology KB: data collection, data analysis, writing, review, editing, and final approval of the version to be published. Acknowledgements The authors are grateful to Kanit Bunnag, Amarit Tansawet, Patcharamanee Wangchalabovorn for advice and support. Author details 1 Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. 2 Phra Phutthabat hospital, Saraburi, Thailand. References Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Kao L et al. SCHWARTZ'S PRINCIPLES OF SURGERY 2-volume set 11th edition: McGraw Hill LLC; 2019. Flint PW, Haughey BH, Francis HW, Lund VJ, Lesperance MM, Robbins KT, Thomas JR. Cummings Otolaryngology: Head and Neck Surgery: Elsevier; 2020. Myers EN, Snyderman CH. Operative Otolaryngology: Head and Neck Surgery. 2-Volume Set: Elsevier; 2018. Maklebust JA, Sieggreen M. Pressure Ulcers: Guidelines for Prevention and Management. Springhouse Corporation; 2001. Bodenham A, Bell D, Bonner S, Branch F, Dawson D, Morgan P, et al. Standards for the care of adult patients with a temporary tracheostomy; Standards and Guidelines. Intensive Care Soc. 2014;2014:29–32. DD CB. 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Gauze versus solid skin barrier for tracheostomy care: a crossover randomized clinical trial. J Wound Ostomy Cont Nurs. 2013;40(6):573–9. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155–63. Kuo CY, Wootten CT, Tylor DA, Werkhaven JA, Huffman KF, Goudy SL. Prevention of pressure ulcers after pediatric tracheotomy using a Mepilex Ag dressing. Laryngoscope. 2013;123(12):3201–5. Kalowes P, Messina V, Li M. Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit. Am J Crit Care. 2016;25(6):e108–19. Walker RM, Gillespie BM, Thalib L, Higgins NS, Whitty JA. Foam dressings for treating pressure ulcers. Cochrane Database Syst Rev. 2017;10(10):Cd011332. Lippert D, Hoffman MR, Dang P, McMurray JS, Heatley D, Kille T. Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change. Int J Pediatr Otorhinolaryngol. 2014;78(12):2281–5. Yue M, Lei M, Liu Y, Gui N. The application of moist dressings in wound care for tracheostomy patients: A meta-analysis. J Clin Nurs. 2019;28(15–16):2724–31. Ghadially R, Halkier-Sorensen L, Elias PM. Effects of petrolatum on stratum corneum structure and function. J Am Acad Dermatol. 1992;26(3 Pt 2):387–96. Jankowski A, Dyja R, Sarecka-Hujar B. Dermal and Transdermal Delivery of Active Substances from Semisolid Bases. Indian J Pharm Sci. 2017;79:488–500. Additional Declarations No competing interests reported. Supplementary Files CONSORT2010CompletedChecklistBMCSurgery.pdf Cite Share Download PDF Status: Published Journal Publication published 03 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 18 May, 2025 Reviewers agreed at journal 18 May, 2025 Reviews received at journal 17 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers agreed at journal 13 May, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 11 May, 2025 Reviewers agreed at journal 10 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviews received at journal 07 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 29 Apr, 2025 Editor assigned by journal 29 Apr, 2025 Editor invited by journal 25 Apr, 2025 Submission checks completed at journal 24 Apr, 2025 First submitted to journal 24 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":50882,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6396685/v1/30f68ea6cd60284e3b816f6c.png"},{"id":82152155,"identity":"836ba6ce-6426-416a-a9c7-920ee95a5405","added_by":"auto","created_at":"2025-05-07 07:22:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45932,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6396685/v1/ea87263d4a598d68b15719e8.png"},{"id":82152142,"identity":"49ac4bf4-213b-4a11-b4a9-e74f7aba86b4","added_by":"auto","created_at":"2025-05-07 07:22:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46116,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6396685/v1/ba2f5b07250c900ab9311112.png"},{"id":92884623,"identity":"1e219513-9943-4765-b635-050efbb594e8","added_by":"auto","created_at":"2025-10-06 16:13:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1644998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6396685/v1/2b7411d7-9226-4f1a-8853-4642f2665969.pdf"},{"id":82152143,"identity":"7eb36c3d-2ce4-4f3b-9f74-c258077da1a7","added_by":"auto","created_at":"2025-05-07 07:22:59","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41507,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2010CompletedChecklistBMCSurgery.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6396685/v1/e1d9a26732aafee44182197f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Petroleum Jelly vs. Saline in Tracheostomy Wound Care and Ulcer Prevention: A Randomized Controlled Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTracheostomy,(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) a surgical procedure, establishes a direct passage between the trachea and the anterior neck skin, serving various purposes, such as managing upper airway obstructions and addressing conditions, such as severe obstructive sleep apnea, prolonged mechanical ventilation, and laryngeal or head and neck cancer. Regular post tracheostomy monitoring is crucial to assess patients\u0026rsquo; conditions and replace the tracheostomy tube as needed, with complications including bleeding, tube obstruction, pressure ulcers, and wound infections.\u003c/p\u003e \u003cp\u003ePressure ulcers(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) represent a significant concern following tracheostomy. Preventive measures entail meticulous wound care,(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) which includes cleansing the skin around the tube with saline-soaked gauze or cotton and positioning gauze under the tube to prevent direct contact between the tube and skin. This approach not only improves patients\u0026rsquo; quality of life but also accelerates hospital discharge, leading to shorter hospital stays.\u003c/p\u003e \u003cp\u003eThis study aimed to compare the efficacy of petroleum jelly application and sodium chloride irrigation in preventing pressure ulcers and promoting tracheostomy wound healing, with the ultimate goal of improving patients\u0026rsquo; quality of life and accelerating hospital discharge, thereby leading to shorter hospital stays.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e A prospective randomized controlled trial, approved by the Research Ethics Review Committee (IRB no: 163/64FB), included 28 participants aged 18\u0026ndash;80 years who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University, between November 2021 and December 2022. The exclusion criteria included tracheostomy procedures in patients with coronavirus disease 2019, emergency tracheostomy procedures, and tracheostomy procedures involving neck surgery or neck masses. The discontinuation criteria included death or the inability to care for the tracheostomy wound by dressing alone, such as requiring surgical debridement. Clinical trial number: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. \u003cem\u003eRetrospectively registered.\u003c/em\u003e This study adheres to the CONSORT guidelines for the reporting of randomized controlled trials. No interim analyses or early stopping guidelines were planned for this trial.\u003c/p\u003e \u003cp\u003eThe sample size(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) was determined using the following formula for randomized control trials:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:{n}_{trt\\:}=\\frac{{{(z}_{1-\\frac{\\alpha\\:}{2}}+{z}_{1-\\beta\\:})}^{2}\\left[{{\\sigma\\:}_{trt}}^{2}\\right.+\\frac{{{\\sigma\\:}_{con}}^{2}}{r}]}{{\\varDelta\\:}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eσ\u003csub\u003etrt\u003c/sub\u003e \u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;a standard deviation in treatment group\u003c/p\u003e \u003cp\u003eσ\u003csub\u003econ\u003c/sub\u003e \u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;a standard deviation in control group\u003c/p\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;Ratio (control/treatment)\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003eα\u0026thinsp;=\u0026thinsp;0.05, Z(0.95)\u0026thinsp;=\u0026thinsp;1.96\u003c/p\u003e \u003cp\u003eβ\u0026thinsp;=\u0026thinsp;0.20, Z(0.80)\u0026thinsp;=\u0026thinsp;0.84\u003c/p\u003e \u003cp\u003eSample size: treatments\u0026thinsp;=\u0026thinsp;11, controls\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003cp\u003eAfter using a continuity correction, the sample size of each group was 14 participants.\u003c/p\u003e \u003cp\u003e The participants were randomized using a block of four randomization methods into either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group to compare their efficacy in preventing pressure ulcers and promoting tracheostomy wound healing. The random allocation sequence was generated by a statistician independent of the trial and was concealed using sealed, opaque, sequentially numbered envelopes. These envelopes were opened by the otolaryngology resident only after the participant's enrollment and baseline assessment, ensuring that the allocation remained concealed until the intervention was assigned. Wound care after a tracheotomy begins the day following the procedure. For the saline group, wounds are cleaned with saline solution and then covered with gauze. In the petroleum jelly group, wounds are cleaned similarly with saline, followed by the application of 0.5 grams of petroleum jelly around the wound edges, and then covered with gauze. Both groups receive daily care from trained otolaryngology residents or nurses, with caregivers continuing the care at home.\u003c/p\u003e \u003cp\u003eThe outcomes were assessed by one physician and one nurse at 1, 2, and 4 weeks postoperatively using the Pressure Ulcer Scale for Healing(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (PUSH) Tool and Skin Integrity Score.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) (Fig.\u0026nbsp;1) (Fig.\u0026nbsp;2) Importantly, the outcome assessors were blinded to the group assignments to minimize bias in the evaluation of wound healing.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous data are presented as means and standard deviations if the data were normally distributed. Otherwise, they are presented as medians (with ranges). The corresponding significance tests were conducted using an independent t-test or the Mann\u0026ndash;Whitney U test. Categorical data are presented as frequencies and percentages and were compared using Fisher\u0026rsquo;s exact test. Interrater reliability was assessed using the Intraclass Correlation Coefficient. All analyses were performed using SPSS version 26.0, with \u003cem\u003ep\u003c/em\u003e-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 denoting statistical significance. No subgroup or ancillary analyses were performed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Characteristics\u003c/h2\u003e \u003cp\u003eThe 28 patients who underwent tracheostomy procedures were randomly assigned to two groups. Fourteen patients used petroleum jelly for dressing their wounds, whereas the other 14 patients used sodium chloride irrigation (0.9% NaCl solution) for dressing their wounds. The study found no differences in basic demographic information. In the petroleum jelly application group, seven were female patients and seven were male patients, with an average age of 65.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.38 years. In the sodium chloride irrigation group, four were female patients and 10 were male patients, with an average age of 66.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.94 years.\u003c/p\u003e \u003cp\u003eNo significant differences in other demographic characteristics were observed between the two groups, including height, weight, body mass index, hemoglobin, hematocrit, serum albumin, serum creatinine, aspartate aminotransferase, alanine aminotransferase, diabetes mellitus, smoking history, and history of infection, including sepsis, pneumonia, and other infections. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristic of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePetroleum jelly\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.29\u0026thinsp;\u0026plusmn;\u0026thinsp;12.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.771\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.246\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeight (cm.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.320\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg.)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.14\u0026thinsp;\u0026plusmn;\u0026thinsp;14.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.825\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI ( kg/cm\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.97\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.746\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHb (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.837\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHct (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.46\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.744\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerum Albumin (g/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.694\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSerum Creatinine (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.55\u0026ndash;4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.83 (0.33\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.927\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAST (U/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.5 (19\u0026ndash;150)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (12\u0026ndash;170)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.629\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALT ( U/l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (6\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5 (5\u0026ndash;97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.597\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetic mellitus (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.699\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (57.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (64.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (35.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (57.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (35.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (42.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (64.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharacteristic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePetroleum jelly\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of infection (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e- Sepsis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.445\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (64.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (35.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e- Pneumonia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (35.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (64.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e- Other\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (85.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (14.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (21.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as number (%), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range)\u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eP-value from Chi-square test\u003c/p\u003e \u003cp\u003e \u003csup\u003eb\u003c/sup\u003eP-value from Fisher\u0026rsquo;s exact test\u003c/p\u003e \u003cp\u003e \u003csup\u003ec\u003c/sup\u003eP-value from Independent samples t-test\u003c/p\u003e \u003cp\u003e \u003csup\u003ed\u003c/sup\u003eP-value from Mann-Whitney U test\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePUSH Tool\u003c/h3\u003e\n\u003cp\u003eTracheostomy wound healing was compared between the two groups using the PUSH(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Tool) at weeks 1, 2, and 4 postoperatively, evaluated by one physician and one nurse. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Fig.\u0026nbsp;3)\u003c/p\u003e \u003cp\u003eThe study results from physician assessments showed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (8.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), 2 (7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), and 4 (6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009).\u003c/p\u003e \u003cp\u003eThe study findings from nurse assessments revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), 2 (7.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 9.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and 4 (7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe combined assessment results from the physician and nurse showed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (8.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009), 2 (7.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 9.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), and 4 (6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 8.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003eFrom the assessment of wound healing scores using the PUSH Tool, it was found that the petroleum jelly application group had significantly lower average wound healing scores than the sodium chloride irrigation group, with statistical significance in the assessments conducted by both the physician and nurse and in the combined assessments by the physician and nurse.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe Pressure Ulcer Scale for Healing (PUSH Tool)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe Pressure Ulcer Scale for Healing (PUSH Tool)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePetroleum Jelly (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14) \u003c/p\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvaluated by physician\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvaluated by nurse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvaluated by physician and nurse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e8.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ep-value from Independent t-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSkin Integrity Score\u003c/h3\u003e\n\u003cp\u003eSkin integrity(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) of tracheostomy wounds after surgery was compared between the two groups, assessed by one physician and one nurse each, using the Skin Integrity Score at weeks 1, 2, and 4. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Fig.\u0026nbsp;4)\u003c/p\u003e \u003cp\u003eThe study findings from physician assessments revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (median\u0026thinsp;=\u0026thinsp;5 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 2 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), 2 (median\u0026thinsp;=\u0026thinsp;6 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), and 4 (median\u0026thinsp;=\u0026thinsp;6.5 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010).\u003c/p\u003e \u003cp\u003eThe study findings from nurse assessments revealed that at weeks 1 and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation, with statistically significant differences at weeks 1 (median\u0026thinsp;=\u0026thinsp;4 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 3 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) and 4 (median\u0026thinsp;=\u0026thinsp;6 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). However, in week 2, the scores showed no statistically significant difference (median\u0026thinsp;=\u0026thinsp;6 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.237).\u003c/p\u003e \u003cp\u003eThe combined assessment results from the physician and nurse revealed that at weeks 1, 2, and 4, the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistically significant differences at weeks 1 (median\u0026thinsp;=\u0026thinsp;4.5 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 2.5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), 2 (median\u0026thinsp;=\u0026thinsp;6 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 5 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), and 4 (median\u0026thinsp;=\u0026thinsp;6.25 in the petroleum jelly application group \u003cem\u003evs.\u003c/em\u003e 4.75 in the control group, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010).\u003c/p\u003e \u003cp\u003eFrom the assessment of skin integrity scores for tracheostomy wounds, it was found that the petroleum jelly application group had significantly higher median skin integrity scores than the sodium chloride irrigation group, with statistical significance in assessments conducted by both the physician and nurse and in the combined assessments by the physician and nurse.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSkin integrity score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin Integrity score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePetroleum Jelly (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14) \u003c/p\u003e \u003cp\u003eMedian (min-max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluated by physician\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.5 (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvaluated by nurse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEvaluated by physician and nurse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (2\u0026ndash;5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.25 (4.5\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.75 (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData are presented as median (interquartile range)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ep-value from Mann-Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInterrater reliability\u003c/h2\u003e \u003cp\u003eThe interrater reliability assessments using the ICC(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) for the PUSH Tool at weeks 1, 2, and 4 were 0.957 (95% confidence interval [CI]: 0.906\u0026ndash;0.980, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 0.926 (95% CI: 0.841\u0026ndash;0.966, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 0.923 (95% CI: 0.834\u0026ndash;0.964, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively.\u003c/p\u003e \u003cp\u003eThe interrater reliability assessments using the ICC(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) for the Skin integrity Score at weeks 1, 2, and 4 were 0.947 (95% CI: 0.886\u0026ndash;0.976, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), 0.848 (95% CI: 0.671\u0026ndash;0.930, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 0.970 (95% CI: 0.935\u0026ndash;0.986, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively.\u003c/p\u003e \u003cp\u003e From the assessment results, there was a high level of agreement among the assessors, which was statistically significant. The reliability between assessors fell within the range of 0.75\u0026ndash;1.00, indicating good to excellent agreement among them. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNo adverse events or unintended effects were reported in either group during the study period.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInter-rater reliability\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInter-rater reliability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePUSH Tool\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.980\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSkin Integrity score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eweek 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eICC\u0026thinsp;=\u0026thinsp;Intraclass Correlation Coefficient\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePressure ulcers and wound healing following tracheostomy procedures present a significant concern and impacts the quality of life of patients. In Thailand, accessing moisture-retentive dressings, such as Mepilex Ag,(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) foam dressings,(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Drain sponge,(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) and solid skin barriers, is challenging because of their high cost and the requirement for daily changes. Meng Yue et al.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) found that moisture-retentive wound dressings can better prevent and reduce the occurrence of pressure ulcers. Petroleum jelly(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) is one such moisture-retentive substance with properties that prevent water loss and increase skin moisture, aiding in moisture retention and reducing the occurrence of pressure ulcers. Furthermore, it is easy to use; is cost-effective; has specific properties, such as nonabsorption into the bloodstream; is suitable for most skin types; has a nonirritating nature; and has efficacy comparable to that of other moisture-retentive wound dressings. Therefore, it is being used in this research project.\u003c/p\u003e \u003cp\u003eThe population included in this study primarily comprised males aged between 18 and 80 years who underwent tracheostomy procedures. According to the study findings, petroleum jelly was effective in preventing pressure ulcers and promoting wound healing, as assessed by the PUSH(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Tool and Skin Integrity(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Score. These assessments revealed statistically significant improvements compared with normal saline solution. The consistency of assessment results between the physician and nurse, along with statistically significant interrater reliability, further supports the effectiveness of petroleum jelly.\u003c/p\u003e \u003cp\u003eEach participant underwent a medical history review and physical examination, which was conducted by a single physician (the researcher). This approach was employed to minimize potential discrepancies that could arise from multiple examiners. The purpose of these procedures was to accurately classify the target groups and to explain the utilization of tools, wound care procedures, and data collection methods.\u003c/p\u003e \u003cp\u003eFrom this study, it was observed that the use of petroleum jelly was effective in preventing pressure ulcers and facilitating wound healing in patients undergoing tracheostomy procedures. The results are consistent with those of Meng Yue et al.,(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) who found that wound care using moist dressings can prevent and reduce the occurrence of pressure ulcers.\u003c/p\u003e \u003cp\u003eThe limitations of this study include its small sample size, which may not fully reflect the diversity of the population undergoing tracheostomy procedures. Furthermore, having only two evaluators could introduce potential biases in the assessments because different evaluators may have varying perspectives and interpretations. Moreover, the study only experimented with one type of petroleum jelly, particularly the product from the hospital\u0026rsquo;s production. This limitation restricts the generalizability of the findings to other types of petroleum jelly products available in the market.\u003c/p\u003e \u003cp\u003eTo address these limitations and further develop the research, the researchers suggest increasing the sample size to enhance the representativeness of the findings. Expanding the number of evaluators, including both physicians and nurses, can provide a more comprehensive assessment and reduce potential biases. Furthermore, future studies could explore the efficacy of different materials and compare them with petroleum jelly to determine the most effective option for preventing pressure ulcers and facilitating wound healing in patients undergoing tracheostomy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Participants who received petroleum jelly application following tracheostomy exhibited better results in preventing pressure ulcers and maintaining skin integrity than those who received sodium chloride irrigation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePUSH Tool the Pressure Ulcer Scale for Healing Tool\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adhered to the principles outlined in the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eApproval was granted by the Research Ethics Review Committee of the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand (approval number: 163/64FB).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrial registration: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. \u003cem\u003eRetrospectively registered.\u003c/em\u003e (https://www.thaiclinicaltrials.org/show/TCTR20240806002)\u003c/p\u003e\n\u003cp\u003eAll participants or their legal guardians provided written informed consent prior to enrollment in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe full trial protocol or the datasets used and/or analyzed in this present study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no funding, financial relationships, or conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCC: conceptualization, methodology, data collection, data analysis, draft writing and final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003eSU: conceptualization, methodology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKB: data collection, data analysis, writing, review, editing, and final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to Kanit Bunnag, Amarit Tansawet, Patcharamanee Wangchalabovorn for advice and support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eDepartment of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. \u003csup\u003e2 \u0026nbsp;\u003c/sup\u003e Phra Phutthabat hospital, Saraburi, Thailand.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Kao L et al. SCHWARTZ'S PRINCIPLES OF SURGERY 2-volume set 11th edition: McGraw Hill LLC; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlint PW, Haughey BH, Francis HW, Lund VJ, Lesperance MM, Robbins KT, Thomas JR. Cummings Otolaryngology: Head and Neck Surgery: Elsevier; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMyers EN, Snyderman CH. Operative Otolaryngology: Head and Neck Surgery. 2-Volume Set: Elsevier; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaklebust JA, Sieggreen M. Pressure Ulcers: Guidelines for Prevention and Management. Springhouse Corporation; 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBodenham A, Bell D, Bonner S, Branch F, Dawson D, Morgan P, et al. Standards for the care of adult patients with a temporary tracheostomy; Standards and Guidelines. Intensive Care Soc. 2014;2014:29\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDD CB. Guidelines for the Care of Patients with Tracheostomy Tubes: St George\u0026rsquo;s Healthcare NHS Trust2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosner BA. Fundamentals of biostatistics. Thomson-Brooks/Cole Belmont, CA; 2006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRutterford C, Copas A, Eldridge S. Methods for sample size determination in cluster randomized trials. Int J Epidemiol. 2015;44(3):1051\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYapucu G\u0026uuml;neş U, Eşer I. Effectiveness of a honey dressing for healing pressure ulcers. J Wound Ostomy Cont Nurs. 2007;34(2):184\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanel NPIA, Haesler EPUAP, Panel E, Alliance EPUA, Panel PPPI. EPUA, et al. Prevention and Treatment of Pressure Ulcers/Injuries: The International Guideline 2019: Clinical Practice Guideline. Cambridge Media; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStotts NA, Rodeheaver GT, Thomas DR, Frantz RA, Bartolucci AA, Sussman C, et al. An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH). J Gerontol Biol Sci Med Sci. 2001;56(12):M795\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChuang WL, Huang WP, Chen MH, Liu IP, Yu WL, Chin CC. Gauze versus solid skin barrier for tracheostomy care: a crossover randomized clinical trial. J Wound Ostomy Cont Nurs. 2013;40(6):573\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuo CY, Wootten CT, Tylor DA, Werkhaven JA, Huffman KF, Goudy SL. Prevention of pressure ulcers after pediatric tracheotomy using a Mepilex Ag dressing. Laryngoscope. 2013;123(12):3201\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalowes P, Messina V, Li M. Five-Layered Soft Silicone Foam Dressing to Prevent Pressure Ulcers in the Intensive Care Unit. Am J Crit Care. 2016;25(6):e108\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker RM, Gillespie BM, Thalib L, Higgins NS, Whitty JA. Foam dressings for treating pressure ulcers. Cochrane Database Syst Rev. 2017;10(10):Cd011332.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLippert D, Hoffman MR, Dang P, McMurray JS, Heatley D, Kille T. Care of pediatric tracheostomy in the immediate postoperative period and timing of first tube change. Int J Pediatr Otorhinolaryngol. 2014;78(12):2281\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYue M, Lei M, Liu Y, Gui N. The application of moist dressings in wound care for tracheostomy patients: A meta-analysis. J Clin Nurs. 2019;28(15\u0026ndash;16):2724\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhadially R, Halkier-Sorensen L, Elias PM. Effects of petrolatum on stratum corneum structure and function. J Am Acad Dermatol. 1992;26(3 Pt 2):387\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJankowski A, Dyja R, Sarecka-Hujar B. Dermal and Transdermal Delivery of Active Substances from Semisolid Bases. Indian J Pharm Sci. 2017;79:488\u0026ndash;500.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"tracheostomy, petroleum jelly, the Pressure Ulcer Scale for Healing (PUSH Tool), Skin Integrity Score","lastPublishedDoi":"10.21203/rs.3.rs-6396685/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6396685/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e This study aimed to compare the efficacy of petroleum jelly application and sodium chloride irrigation in preventing pressure ulcers and promoting tracheostomy wound healing. Trial registration: TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. \u003cem\u003eRetrospectively registered. (https://www.thaiclinicaltrials.org/show/TCTR20240806002)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e: Prospective randomized controlled trial\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e: Tertiary referral center, a university-based hospital\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study enrolled 28 participants, aged 18–80 years, who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University. They were randomly assigned using a block of four randomization methods to either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group. The outcomes were evaluated by one physician and one nurse at 1, 2, and 4 weeks postoperatively using the Pressure Ulcer Scale for Healing (PUSH) Tool and Skin Integrity Score.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The petroleum jelly application group demonstrated significantly lower mean scores on the PUSH Tool at 1, 2, and 4 weeks than the sodium chloride irrigation group. Moreover, the petroleum jelly application group exhibited significantly higher median scores for skin integrity at 1, 2, and 4 weeks than the sodium chloride irrigation group. The interrater reliability between the two assessors was good to excellent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The participants who received petroleum jelly application following tracheostomy demonstrated better results in preventing pressure ulcers and maintaining skin integrity compared with those who received sodium chloride irrigation.\u003c/p\u003e","manuscriptTitle":"Petroleum Jelly vs. Saline in Tracheostomy Wound Care and Ulcer Prevention: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 07:22:54","doi":"10.21203/rs.3.rs-6396685/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T10:29:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T00:50:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214803270087193387955272855330029667252","date":"2025-05-18T23:58:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-17T14:23:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21988860711228922021590425650253683665","date":"2025-05-16T00:36:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271901297006446780159495372547391661118","date":"2025-05-13T21:01:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-13T13:49:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271483395904690821019286037157836571450","date":"2025-05-11T09:45:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318665652093191121534602379789446462473","date":"2025-05-10T08:52:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"186744058334242509764002566554941934287","date":"2025-05-08T07:11:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-07T21:03:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105936518823422984477340508528358844543","date":"2025-05-07T20:30:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-29T12:55:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-29T12:49:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-25T07:49:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-24T13:26:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-04-24T13:25:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96814867-a9a6-4ad7-a582-a893249782f1","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:11:42+00:00","versionOfRecord":{"articleIdentity":"rs-6396685","link":"https://doi.org/10.1186/s12893-025-03224-w","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-10-03 15:57:27","publishedOnDateReadable":"October 3rd, 2025"},"versionCreatedAt":"2025-05-07 07:22:54","video":"","vorDoi":"10.1186/s12893-025-03224-w","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03224-w","workflowStages":[]},"version":"v1","identity":"rs-6396685","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6396685","identity":"rs-6396685","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}