Patients with tracheostomy indication in an intensive care cohort
Introduction: Tracheostomy is a procedure indicated for patients with extended mechanical ventilation.
Objective: The objective of the study was to learn about the technical characteristics, the appropriate timing for the procedure and its evolution.
Material and method: Observational, retrospective study of ICU admitted patients during 2012, with elective tracheostomy. The demographic variables, the Apache II, the pathologies, the number of days in MV, length of stay and mortality were analyzed, both globally and by groups, depending on the early or late use of the technique. The study was approved by the Ethics Committee for Clinical Research of the institution, in accordance with the institutional bioethical principles.
Results: The mean age in the sample with 42 patients was 61.36, and the mean Apache II was 18. The most frequent pathology was neurological. The approach was percutaneous in 71.5%, with minor complications in 20% of the cases. In the early tracheostomy group, the number of days in MV and the length of stay were both considerably shorter.
Conclusions: Elective tracheostomy is a commonly used technique in the ICU and the procedure is performed according to the protocol. The percutaneous approach is the most frequently used, with few complications. In neurological critical patients with extended weaning, an early approach reduces the number of days with ventilation and the length of stay, with no positive impact on mortality.
2. Clec'h C, Alberti C, Vincent F, Garrouste-Orgeas M, de Lassence A, Toledano D, et al. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis. Crit Care Med. 2007;35:132-8.
3. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and metaanalysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;33:1243.
4. Calvache JA, Molina García RA, Trochez AL, Benitez F, Arroyo L. Traqueostomía percutánea por dilatación sin fibrobroncoscopio. Evaluación de 80 casos en cuidados intensivos. Rev Colomb Anestesiol. 2013;41:184-9.
5. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59:895-915.
6. Dunham CM, Ransom KJ. Assessment of early tracheostomy in trauma patients: a systematic review and meta-analysis. Am Surg. 2006;72:276-81.
7. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs. late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303:1483-9.
8. Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg. 2014;76:70-6.
9. Gomes Silva BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2012;3. CD007271.
Copyright (c) 2016 Sociedad Colombiana de Anestesiología y Reanimación. S.C.A.R.E
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.