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Mascia, Luciana; Corno, Eleomore; Terragni, Pierpaolo; Stather, David R.; Ferguson, Niall D.

doi:10.1186/cc2864

Cited by 20 publications

(5 citation statements)

References 19 publications

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“…[ 18 ] During the first hours following trauma, intubation and mechanical ventilation can be required for several reasons: Coma, acute respiratory failure, uncontrolled shock…[ 19 ] However, after the acute phase, most of these patients need intubation mainly for airway protection, which may considerably delay extubation, prolonger sedation and mechanical ventilation. [ 20 21 ] For all these reasons, tracheotomy represents an attractive procedure for airway management in this specific group of patients. [ 2 19 ] On the other hand, tracheotomy is not without risk and serious complications such as bleeding events, canula misplacement, barotraumas or stomal infections can complicate the immediate or the late course of tracheotomized patients.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

Chaari

Kssibi

Zribi

et al. 2013

J Emerg Trauma Shock

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Objective:To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients.Materials and Methods:We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied.Results:We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality.Conclusion:Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn’t increase mortality.

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Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

Chaari

Kssibi

Zribi

et al. 2013

J Emerg Trauma Shock

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“…The treatment usually lasts for 7 days if the patient progresses favourably; although it might be extended in patients where Pseudomonas aeruginosa is identified since infection by this organism is associated with high rates of relapse. 37 …”

Section: Pneumoniamentioning

confidence: 99%

Pulmonary Complications in Patients with Brain Injury

Alvarez¹,

Quevedo²,

Furelos³

et al. 2015

Pulm Res Respir Med Open J

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“…Although tracheostomy is an increasingly used procedure, it may be associated with complications including stomal infection, stomal haemorrhage, major vascular injury, pneumothorax, subglottic stenosis, and tracheoesophageal fistulae, therefore, a decision to perform the procedure should not be taken lightly 20 . We observed tracheostomy tube occlusion, surgical site bleeding and surgical site infection to be the most common complications in our patients with an overall tracheostomy complication rate of 11.3%.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

et al. 2022

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Background Tracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi. Methods This is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management. Results In our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%. Conclusion Tracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.

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Cited by 20 publications

References 19 publications

Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

Pulmonary Complications in Patients with Brain Injury

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

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