Early versus late percutaneous tracheostomy in critically ill adult mechanically ventilated patients

Mohamed, Kamel Abd Elaziz; Mousa, Ahmed; Elsawy, Ahmed Samir; Saleem, Adel Mohamed

doi:10.1016/j.ejcdt.2014.01.008

Cited by 21 publications

(36 citation statements)

References 28 publications

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“…In the RCT by Tong et al, 25 it was found that early tracheostomy reduced ICU LOS by 33%. Similarly, in the RCT conducted by Mohamed et al, 27 the ICU LOS was shorter in the early PDT group as compared to late PDT group (32.2 ± 10.5) vs (20.6 ± 13 days; p = 0.004). In the RCT conducted by Terragni et al, 17 the ICU free days were significantly higher in the early tracheostomy group as compared to the late group.…”

Section: Does Early Tracheostomy Reduce the Icu Length Of Stay (Los) supporting

confidence: 53%

“…Wang et al 18 showed that early tracheostomy did not reduce the short term mortality (RR, 0.86; 95% CI, 0.65-1.13; P = 0.28) as shown by seven trials (N = 1044) 13,[15][16][17][19][20][21] as well as long term mortality (RR, 0.86; 95% CI, 0.65-1.13; P = 0.28) as shown by two trials (N = 443). 17,21 In another meta-analysis conducted by Meng et al, 26 nine studies 13,15,17,[19][20][21]27,29,34 were included and the result was that early tracheostomy did not reduce the mortality [relative risk (RR) = 0.88; 95% CI = 0.76-1.00; P = 0.06]. Szakmany et al 35 [13][14][15][16][17][19][20][21]29,34,37,45,47 concluded that the all-cause mortality was not lower in early tracheostomy as compared to late or no tracheostomy group (303 vs 345 deaths; OR 0.80, 95% CI 0·59-1·09; p = 0.16).…”

Section: Does Early Tracheostomy Reduce the Mortality In Critically Imentioning

confidence: 99%

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Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Gupta¹,

Dixit²,

Choudhry

et al. 2019

Indian Journal of Critical Care Medicine

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Background and Aim: Critically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study "DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)" followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs. Materials and methods: All existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation. Results: After analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity. Conclusion: This document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients.

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Section: Does Early Tracheostomy Reduce the Icu Length Of Stay (Los) supporting

confidence: 53%

Section: Does Early Tracheostomy Reduce the Mortality In Critically Imentioning

confidence: 99%

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Gupta¹,

Dixit²,

Choudhry

et al. 2019

Indian Journal of Critical Care Medicine

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“…Mevcut çalışmalarda trakeostomi uygulanması ile VİP gelişimi arasındaki süre çok değişkendir, spesifik bir zaman belirtilmemiş-tir. Nseir ve ark.nın (14) Yakın zamanda trakeostomi ve VİP gelişimine ilişkin çalışmalar Tablo 1'de özetlenmiştir (38)(39)(40)(41)(42)(43)(44)(45). VİP tanımı için genellikle Center of Disease Control (CDC) ve CPIS skorunun kullanıldığı çalışmalarda erken trakeostomi açılan grup ile geç trakeostomi açılan grup arasında VİP insidansı açısından fark tespit edilmemiştir.…”

Section: Trakeostomi Zamanı Ve Ventilatör İlişkili Pnömoniunclassified

Relationship between Tracheostomy and Ventilator-associated Pneumonia in Intensive Care

Yıldırım¹,

Tahir²

2017

Yoğun Bakim Derg

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Tracheostomy is one of the most frequently performed surgical procedures in intensive care units (ICUs) for preventing complications caused by prolonged mechanical ventilation. Tracheostomy is advised to remove tracheobronchial secretions, facilitate weaning, and promote early oral feeding. Ventilator-associated pneumonia (VAP) is hospitalacquired pneumonia that develops 48 h after endotracheal intubation in patients without pneumonia at the beginning of intubation. VAP is a significant cause of mortality and morbidity, particularly in critically ill patients. In addition to its already known advantages, it is a debatable issue whether tracheostomy is a risk factor for VAP. The timing of the procedure is a topic that has been discussed in the literature. Previous studies have revealed that tracheostomy can be performed when the predicted intubation duration is 2 weeks or more. In this review, early or late tracheostomy and its effect on VAP development in ICUs will be discussed along with current literature. Trakeostomi yoğun bakım ünitelerinde (YBÜ) genellikle uzamış mekanik ventilasyonun (MV) yarattığı komplikasyonları önlemek için uygulanan bir cerrahi işlemdir. Trakeobronşiyal sekresyonların kolay uzaklaştırılması, MV'den ayrılmayı (weaning) kolaylaş-tırması ve erken oral beslenme sağlaması açısından tavsiye edilen bir uygulamadır. Ventilatör ilişkili pnömoni (VİP); entübasyon sırasında pnömonisi olmayan hastalarda endotrakeal entübasyondan 48 saat sonra gelişen hastane kökenli pnömonidir. VİP, kritik hastalarda önemli bir morbidite ve mortalite nedenidir. Trakeostominin bilinen avantajlarına ek olarak VİP açısından bir risk oluşturup oluşturmadığı ve zamanlaması halen literatürde tartışılan bir konudur.Yapılan çalışmalarla 2 haftadan daha uzun süre entübe kalacağı öngörülen hastalarda erken trakeostomi açılması önerilmektedir.Bu derlemede YBÜ'lerde izlenen hastalarda erken veya geç dönemde açılan trakeostominin VİP gelişimi açısından bir önemi olup olmadığı ortaya konulmaya çalışılmıştır. GirişVentilator ilişkili pnömoni (VİP) mekanik ventilasyon (MV) desteği alan kritik hastalarda YBÜ'de en sık karşılaşılan enfeksiyondur. Entübasyon sırasında pnömonisi olmayan, invaziv MV desteğindeki hastada entübas-yondan 48 saat sonra gelişen nozokomiyal pnömoni olarak tanımlanan VİP, entübe hastaların yaklaşık %8-%28'inde gelişir (1, 2). Genellikle medikal YBÜ hastalarında cerrahi YBÜ hastalarına göre daha sık görülür. Kritik hastalarda önemli bir morbidite ve mortalite nedenidir. Mortalite oranları %24 ile %50 arasında değişmekte ve bazı durumlarda %76'ya kadar çıka-bilmektedir (3). Etken mikroorganizmalar YBÜ'nün özelliklerine (medikalcerrahi), hasta popülasyonuna, YBÜ'de kalış süresine ve altta yatan hastalıklara göre değişkenlik gösterir. En sık tespit edilen mikroorganizmalar Pseudomonas aeruginosa, Staphylococcus aureus, Enterobacteriaceae ve ülkemizde Acinetobacter baumanii'dir (4). VİP gelişimi için en önemli risk faktörü MV'de kalış süresidir. Re-entübasyon, akut hastalığın ağırlığı (Acute Physiology and Chro...

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Section: Introductionmentioning

confidence: 99%

“…Recently, the potential advantage of early tracheostomy has attracted considerable attention; several retrospective and prospective studies have suggested a clinical benefit of early tracheostomy on patients requiring prolonged mechanical ventilation. [2][3][4][5][6][7][8][9][10][11] However, the design of these trials is insufficient to investigate the effect of early tracheostomy. For example, in retrospective studies, it is difficult to match patients because there are no consistent indication criteria for tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of early tracheostomy in mechanically ventilated patients

Dochi

Nojima

Matsumura

et al. 2019

Laryngoscope Investig Oto

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Objective To investigate the effect of the timing of tracheostomy in patients who required prolonged mechanical ventilation using two methods: analysis of early versus late tracheostomy and landmark analysis. Study Design Retrospective cohort study. Methods Patients who were emergently intubated and admitted into the intensive care unit or high dependency unit between January 2011 and August 2016, with or without tracheostomy, were included. In the early and late tracheostomy analysis, all patients were divided into early (≤10 days, n = 88) and late (>10 days, n = 132) groups. In the landmark analysis, 198 patients requiring ventilation for more than 10 days were divided into early tracheostomy (≤10 days, n = 57) and nonearly tracheostomy (>10 days, n = 141) groups. We compared 60‐day ventilation withdrawal rate and 60‐day mortality. Results Early tracheostomy was a significant factor for early ventilation withdrawal, as shown by log‐rank test results (early and late tracheostomy: P = .001, landmark: P = .021). Multivariable analysis showed that the early group was also associated with a higher chance of ventilation withdrawal in each analysis (early and late tracheostomy: adjusted hazard ratio [aHR] = 1.69, 95% confidence interval [CI] = 1.20–2.39, P = .003; landmark: aHR = 1.61, 95% CI = 1.06–2.38, P = .027). Early tracheostomy, however, was not associated with improved 60‐day mortality (early and late tracheostomy: aHR = 0.88, 95% CI = 0.46–1.69, P = .71; landmark: aHR = 1.46; 95% CI = 0.58–3.66; P = .42). Conclusion For patients requiring ventilation, performing tracheostomy within 10 days of admission was independently associated with shortened duration of mechanical ventilation; 60‐day mortality was not associated with the timing of tracheostomy. Level of Evidence 2b

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Early versus late percutaneous tracheostomy in critically ill adult mechanically ventilated patients

Cited by 21 publications

References 28 publications

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations

Relationship between Tracheostomy and Ventilator-associated Pneumonia in Intensive Care

Effect of early tracheostomy in mechanically ventilated patients

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