Early versus late tracheostomy for critically ill patients

Andriolo, Brenda Ng; Andriolo, Régis B; Saconato, Humberto; Atallah, Álvaro Nagib; Valente, Orsine

doi:10.1002/14651858.cd007271.pub3

Cited by 295 publications

(313 citation statements)

References 82 publications

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“…Compared to LT or prolonged MV, they did not find significantly difference of ET in terms of short-term mortality [relative risk (RR) = 0.91; 95% confidence intervals (cIs) = 0.81−1.03; P = 0.14] or long-term mortality VAP or duration of MV. This result differs from a recent Cochrane Collaboration review that involved seven randomized controlled trials including 1903 participants where the authors found lower mortality rates in the ET as compared with the LT group (risk ratio=0.83; 95% CI 0.70 to 0.98, P = 0.03) [13].…”

Section: Discussioncontrasting

confidence: 99%

Early versus late tracheostomy in cardiovascular intensive care patients

Puentes

Jerath

Djaiani

et al. 2016

Anaesthesiol Intensive Ther

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Background: Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population. Methods: After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as "early" if < 7 days or "late" if ≥ 7 days post-cardiac surgery). Results: 14,101 patients underwent cardiac surgery over the 7-year study period; from those, 147 (1.36%) received tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P = 0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups. Conclusions: There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.

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Section: Discussioncontrasting

confidence: 99%

Early versus late tracheostomy in cardiovascular intensive care patients

Puentes

Jerath

Djaiani

et al. 2016

Anaesthesiol Intensive Ther

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“…Although, two more recent analyses suggest superiority of early tracheostomy (43,44), the timing of tracheostomy is dependent mostly on individual and institutional practice.…”

Section: Timing Of Tracheostomymentioning

confidence: 99%

Percutaneous tracheostomy: a comprehensive review

Rashid

Islam

2017

J. Thorac. Dis.

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Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world.Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications.PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective.Experience with the technique and careful planning is needed to minimize any avoidable potential complication.

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“…We identified one systematic review from Cochrane database which focused on the timing of tracheostomy in the critically ill (56).…”

Section: Resultsmentioning

confidence: 99%

How should this patient with repeated aspiration pneumonia be managed and treated?—a proposal of the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure

et al. 2016

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Cerebrovascular accident (CVA) is commonly seen among the elderly with a substantial proportion of patients suffering from long-term dysphagia and/or an inability to protect their airway. This potentially imposes on them an increased risk of malnutrition and aspiration pneumonia. In this article, we present a patient with malnutrition and dysphagia secondary to CVA. We propose a procedure for which we will name the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure for placement of percutaneous endoscopic gastrostomy (PEG) and tracheostomy tube (TT) at the same time. The medical literature was systematically reviewed for both PEG and tracheostomy, aiming to provide the state-of-the-art evidence for clinical use of the PENlIGhT procedure. In clinical practice, the PENlIGhT procedure is indicated for patients who are expected to have prolonged swallowing disturbance and mechanical ventilation. Some prediction tools and scores can be helpful to identify such groups of patients. Patients with poor neurological outcomes who require prolonged maintenance of life are also good candidates for the PENlIGhT procedure.

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Early versus late tracheostomy for critically ill patients

Abstract: The whole findings of this systematic review are no more than suggestive of the superiority of early over late tracheostomy because no information of high quality is available for specific subgroups with particular characteristics.

Cited by 295 publications

References 82 publications

Early versus late tracheostomy in cardiovascular intensive care patients

Early versus late tracheostomy in cardiovascular intensive care patients

Percutaneous tracheostomy: a comprehensive review

How should this patient with repeated aspiration pneumonia be managed and treated?—a proposal of the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure

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