Factors Influencing Choice Between Tracheostomy and Prolonged Translaryngeal Intubation in Acute Respiratory Failure

El-Naggar, Moustafa; Sadagopan, Seshadri; Levine, Harry; Kantor, Harvey; Collins, Vincent J.

doi:10.1213/00000539-197603000-00015

Cited by 98 publications

(10 citation statements)

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“…Although prolonged translaryngeal intubation causes tissue trauma, promotes bacterial translocation and infection, and usually requires sedation to reduce patient discomfort, there is little evidence to guide optimal timing for a tracheostomy, in part because of the methodological diversity in the 15 studies and one systematic review which have been conducted in this area (table 8) [109,160,[166][167][168][169][172][173][174][175][176][177][178][179][180][181]. Only eight of these studies are randomised controlled trials, four of which have been published since 1997 [168,169,172,173].…”

Section: Timing Of Tracheostomymentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,660

1,499

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Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

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Section: Timing Of Tracheostomymentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,660

1,499

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“…a1., 8 and Stauffer et al9 compared translaryngeal intubation with tracheostomy in critically ill patients. Outcome analyses centered solely on the complications of tracheostomy and risk of tracheal stenosis.…”

Section: /6/22940mentioning

confidence: 99%

Early tracheostomy for primary airway management in the surgical critical care setting

Rodriguez

Steinberg

Luchetti

et al. 1990

Journal of British Surgery

155

218

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MECHANICAL VENTILATION REQUIRING cannulation of the trachea is an integral part of the therapy provided to patients in the surgical critical care setting. In the 1950s and early 1960s, airway management consisted of a short period of translaryngeal intubation quickly converted to tracheostomy. In the late 1960s and 1970s the time of translaryngeal intubation before tracheostomy gradually increased with the development of improved endotracheal tube design and construction. This concept became the standard of care in critical care units,'-6 irrespective of the type of patient cared for. In the late 1970s and early 1980s Dane and King; El Naggar et a1.,8 and Stauffer et al.9 compared translaryngeal intubation with tracheostomy in critically ill patients. Outcome analyses centered solely on the complications of tracheostomy and risk of tracheal stenosis. These studies have frequently been cited to demonstrate the dangers of tracheostomy and the high incidence of morbidity and death as a result of the procedure and supported prolonged translaryngeal intubation to avoid tracheostomy until absolutely necessary. In several well-performed prospective studies,"-12 the controversy concerning perioperative morbidity and death and timing of tracheostomy after translaryngeal intubation were addressed. These reports demonstrated that morbidity and mortality rates of tracheostomy were low and translaryngeal intubation of less than 7 days was associated with a risk of transient laryngeal injury of less than 10%. Tracheostomy after 7 days of translaryngeal intubation had a significant incidence of irreversible laryngeal and tracheal stenosis. On the other hand, in a prospective,

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“…For all other patients, the decision regarding the timing of tracheostomy was left to daily assessment and physician preference. Such practice was based on earlier reports showing high tracheal stenosis rates with tracheostomy as compared with endotracheal intubation [5,6]. For example, one study reported in 1981 [6] found an incidence of tracheal stenosis after tracheostomy of 65%, as compared with 19% after endotracheal intubation.…”

Section: Introductionmentioning

confidence: 99%

Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review

et al. 2004

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IntroductionDespite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients.MethodsThe following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay.ResultsOf 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P < 0.0001). Similarly, ICU LOS was significantly shorter (10.9 ± 1.2 days versus 21.0 ± 1.3 days; P < 0.0001). Following tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of prolonged ICU stay (>14 days).ConclusionEarly tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients may help in reducing unnecessary resource utilization.

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Factors Influencing Choice Between Tracheostomy and Prolonged Translaryngeal Intubation in Acute Respiratory Failure

Cited by 98 publications

References 0 publications

Weaning from mechanical ventilation

Weaning from mechanical ventilation

Early tracheostomy for primary airway management in the surgical critical care setting

Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review

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