Retrospective clinical study of tracheostomy among intubated patients of respiratory intensive care unit
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20205069Keywords:
Tracheostomy, Prolonged intubation, RICU, Conditional survivalAbstract
Background: Tracheostomy is a common surgical procedure performed in upper airway obstruction to establish alternate airway, to ease the access for secretion removal and protect lower airways and to wean in critically ill, ventilator-dependent patients. This retrospective clinical study emphasises on the indications and clinical outcome of tracheostomy procedure among intubated patients of varied clinical diagnosis in respiratory intensive care unit (RICU).
Methods: This is a retrospective clinical study of intubated patients of RICU who underwent tracheostomy between Jan 2014 to Dec 2019.The case sheets of patients who fulfilled the inclusion criteria of this study and whose records were available in medical records department (MRD) of our institute for the study period were analysed for the indications for tracheostomy, timing of tracheostomy and its clinical outcome among them.
Results: A total of 33 patients were included in this study and their case sheets were analysed. Most common indication for the tracheostomy was found to be prolonged intubation secondary to the chemical poisoning. The mean days of intubation before the tracheostomy was 7 days. The mean days of stay in RICU after tracheostomy among survived and dead patients was 21 and 7 days respectively which was highly significant (p=0.00).
Conclusion: This retrospective study concludes that conditional survival after the tracheostomy among the previously intubated patients is found to be more after three weeks whereas the mortality is likely to be in the first week of post tracheostomy period. Hence the number of days of stay after the tracheostomy among these patients, there need not be a linear decrease in survival and should not be the reason for being despondent.
Metrics
References
Charles G, Durbin J. Tracheostomy: why, when, and how? Respir Care. 2010;55:1056-68.
Barquist ES, Amortegui J, Hallal A, Giannotti G, Giannotti G, MacLeod J. Tracheostomy in ventilator dependent trauma patients: a prospective, randomized intention to treat study. J Trauma. 2006;60(1):91-7.
Diaz-Prieto A, Mateu A, Gorriz M, Ortiga B, Truchero C, Sampietro N et al. A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study. Critical Care. 2014;18(5):585.
Carson SS. Outcomes of prolonged mechanical ventilation. Curr Opin Crit Care. 2006;12:405-11.
Frutos-Vivar F, Esteban A, Apezteguia C, Anzueto A, Nightingale P, Gonzalez M et al. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med. 2005;33(2):290-8.
Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984;94(3):367-77.
Gaynor EB, Greenberg SB. Untoward sequelae of prolonged intubation. Laryngoscope. 1985;95(12):1461-7.
Nseir S, Di Pompeo C, Jozefowicz E, Cavestri B, Brisson H, Nyunga M et al. Relationship between tracheotomy and ventilator-associated pneumonia: a case control study. Eur Respir J. 2007;30:314-20.
Lessard MR, Brochard LJ. Weaning from ventilatory support. Clin. Chest Med. 1996;17:475-89.
Diehl JL, El Atrous S, Touchard D, Lemaire F, Brochard L. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med. 1999;159(2):383-8.
American Thoracic Society; Infectious Diseases Society of America. Guide-lines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40:2890-6.
King C, Moores LK. Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med. 2008;29:253-63.
Pearson FG, Patterson GA. Tracheostomy. In: Pearson FG, Patterson GA, Cooper J. (eds). Pearson’s thoracic and oesophageal Surgery. 3rd ed. New York: Churchill Livingstone. 2008:344-52.
Guarino A. Percutaneous tracheostomy: patient outcomes. It is time to improve our care. Minerva Anestesiol. 2009;75:602-3.
Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheostomy to prolonged translaryngeal intubation (delayed tracheostomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689-94.
Escher M, Ricou B, Nendaz M, Scherer F, Cullati S, Hudelson P et al. ICU physicians’ and internists’ survival predictions for patients evaluated for admission to the intensive care unit. Ann Intensive Care. 2018;8(1):108.
Marshall DC, Hatch RA, Gerry S, Young JD, Watkinson P. Conditional Survival with Increasing Duration of ICU Admission: An Observational Study of Three Intensive Care Databases. Crit Care Med. 2020;48(1):91-7.
Lin WC, Chen CW, Wang JD, Tsai LM. Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes. BMC Anesthesiol. 2015;15:181.
King C, Moores LK. Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med. 2008;29(2):253-63.
Pasqua F, Nardi I, Provenzano A, Mari A. Weaning from tracheostomy in subjects undergoing pulmonary rehabilitation. Multidiscip Respir Med. 2015;10(11):35.
Blot F, Similowski T, Trouillet JL, Chardon P, Korach JM, Costa MA et al. Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med. 2008;34(10):1779-87.
Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275(3):679-90.
