Evidence-based guidelines for the use of tracheostomy in critically ill patients

Raimondi, N.; Vial, Macarena R.; Calleja, J.; Quintero, A.; Cortés, A. Estellés; Celis, Édgar; Pacheco, Carlos Díaz; Ugarte, Sebastián; Añón, J.M.; Hernández, Gónzalo; Vidal, E.; Chiappero, Guillermo; Ríos, Fernando; Castilleja, Fernando; Matos, A.; Rodríguez, E.; Antoniazzi, Paulo; Teles, José; Dueñas, Carmelo; Sinclair, Jorge; Martı́nez, L.; Osten, Ingrid von der; Vergara, José; Jiménez, Edgar; Arroyo, M.; Rodríguez, C.; Torres, Javier A. Sánchez; Fernández-Bussy, Sebastián; Nates, Joel

doi:10.1016/j.jcrc.2016.10.009

Cited by 116 publications

(122 citation statements)

References 93 publications

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“…These recommendations have taken into account certain points mentioned in other international guidelines available on the tracheostomy. [154][155][156][157] references…”

Section: Resultsmentioning

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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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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“…These recommendations have taken into account certain points mentioned in other international guidelines available on the tracheostomy. [154][155][156][157] references…”

Section: Resultsmentioning

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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“…On the other hand, other studies relate tracheostomy to the longer period of me-chanical ventilation, as well as longer ICU stay, leading to a higher risk of acquiring other infections. [37][38][39][40][41][42][43] We have no assumption that nursing workload is the unique contributor related to nursing for the results of any patient outcomes. Other aspects related to nursing such as team qualification, degree of training, level of knowledge, form of work and the impact of students in educational institutions can interfere with patient's outcomes.…”

Section: Discussionmentioning

confidence: 99%

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Gomes¹,

Röder²,

Cunha³

et al. 2019

JNEP

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Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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“…In many cases tracheostomy should be deferred until the patient has ceased viral shedding. In some circumstances, tracheostomy may accelerate ventilator weaning, 4 which might improve throughput of patients with Covid-19 in the hospital system, making room for new patients if ICU resources and ventilators become scarce. This is important since, depending on the trajectory of the pandemic in the USA, it is projected that the need for ventilators may far exceed the number of devices available, currently estimated at approximately 75 000 including those available in the Strategic National Stockpile 13 and another 98 000 ventilators that can perform only basic functions.…”

Section: Considerations For Indications and Timingmentioning

confidence: 99%

“…The risk of complications and death are similar between OT and PT, except that stoma site infections are more common with OT. 4 The choice of OT or PT may be made based on an individual patient's clinical condition, anatomy, the operator's experience with each technique and logistical considerations such as the risk of transportation (if necessary) to the operating room for OT. preparation and procedural safety 1.…”

Section: Procedural Guidance For Open and Percutaneous Tracheostomymentioning

confidence: 99%

“…Bronchoscopy itself is an aerosol-generating procedure and could pose an addition risk of exposure. While there is insufficient evidence that its use decreases the number of complications during tracheostomy, 4 c. If opting not to use bronchoscopy, consider alternative methods to determine withdrawal of the endotracheal tube above the tracheotomy site, including but not limited to: 1. Palpation with a finger on the trachea while the endotracheal tube is being withdrawn; the surgeon can feel the trachea become softer and more pliable as the tube is withdrawn above the proposed tracheotomy site.…”

Section: Percutaneous Tracheostomymentioning

confidence: 99%

See 1 more Smart Citation

Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma

Michetti

Burlew

Bulger

et al. 2020

Trauma Surg Acute Care Open

105

141

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Evidence-based guidelines for the use of tracheostomy in critically ill patients

Cited by 116 publications

References 93 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

The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma

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