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Analysis of a cohort of patients with indication of tracheostomy in intensive care medicine
Intensive Care Medicine Experimentalvolume 3, Article number: A939 (2015)
Tracheostomy is a procedure indicated in prolonged mechanical ventilated (MV) patients. There are controversies regarding the technique, optimal timing, its' influence on MV1 duration, hospital stay and mortality². The divergence of results in the literature justifies further research.
The aim of this study is to know the characteristics of patients with tracheostomy, adecuated technique, timing of realization and evolution.
Observational study of a cohort of patients admitted to ICU during 2012, requiring elective tracheostomy (TQ), according with the actual technique protocol. Demographic variables were analysed, Apache II scale, previous pathologies, MV days, stay and mortality; globally and by groups depending on early or late TQ. In our model, patients were divided into early and late TQ, using the fourteenth day as a cutoff. Recent evidence recommends waiting 10 days to confirm the need for TQ4. The study was approved under the rules of the Ethics Research Commettee.
In our sample of 42 patients mean age was 61.36 years, and median Apache II 18. The most frequent indication was neurocritical patients, being percutaneous TQ in 71.5%, with 20% minor complications. Median days on VM to TQ was 14, IQR [9-17]. Both groups were comparable in age, sex and severity scale. In the early group less number of MV days and stay were significantly observed. There was no significant association between time of TQ and survival (table 1)
Elective tracheostomy is a frequent procedure used in the ICU. The percutaneous technic is the most often used with few complications according with the actual protocol. In neurocritical patients with prolonged weaning its early realization reduces cost effectively the days of MV and stay with no mortality benefit.
Arabi YM, Alhashemi JA, Tamim HM, Esteban A, Haddad SH, Dawood A, et al: The impact of time to tracheostomy on mechanical ventilation duration, length of stay and mortality in intensive care unit patients. J Crit Care. 2009, 24 (3): 435-40. 10.1016/j.jcrc.2008.07.001.
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 (7502): 1243-
Cheung NH, Napolitano LM: Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014, 59 (6): 895-915. 10.4187/respcare.02971.