Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients

Patel, Seraphim; Plowman, Emily K.; Halum, Stacey L.; Meratı, Albert L.; Sardesai, MEd Maya G.

doi:10.1002/lary.25322

Cited by 12 publications

(19 citation statements)

References 17 publications

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“…2 Previously, however, late tracheostomy has been associated with morbidity and mortality. 4 Self-reported adherence to daily sedation interruption was satisfactory and most respondents knew that sedation should be interrupted daily unless contraindicated. Documented adherence to daily sedation interruption was insufficient without any group differences.…”

Section: Discussionmentioning

confidence: 98%

“…For instance, adherence to lung-protective ventilation has been low: patients have received a significantly greater median tidal volume compared to their target tidal volume. [4][5][6] Correspondingly, less than half of respondents have reported using weaning protocols. 7 In addition, significant variation in SBT performance and documentation has been observed worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Jansson

Syrjälä

Ala‐Kokko

2019

American Journal of Infection Control

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Background. Considerable discrepancies have been observed in the implementation of strategies to liberate patients from mechanical ventilation. The aim of this study was to describe critical care nurses' knowledge of and self-reported and documented adherence to lung-protective ventilation, daily sedation interruption, and daily assessment of readiness to extubate and evaluate how these practices differ between patients with and without ventilator-associated pneumonia and between survivors and nonsurvivors. Methods. The survey was conducted in a tertiary-level hospital in Finland from October 2014 to June 2015. Actual adherence was evaluated based on documentation of performed practices. Results. A total of 86 critical care nurses responded to the survey, and 85 patients were followed. The levels of knowledge of and self-reported adherence to low tidal ventilation were 84.5% and 90.2%, respectively, and the median tidal volume was at a target level in 74.4% of patients. Regarding daily sedation interruption, the level of knowledge was 85.7% and the level of self-reported adherence was 77.3% while documented adherence was 33.3%. The levels of knowledge and self-reported adherence regarding spontaneous breathing trial were 61.9% and 71.6%, respectively. Adherence to lungprotective ventilation, daily sedation interruption, and daily assessment of readiness to extubate did not differ between patients with (n=20) and without (n=65) ventilator-associated pneumonia and between survivors (n=55) and nonsurvivors (n=30). Conclusions. Lung-protective ventilation, including low-tidal ventilation and avoidance of high inspiratory plateau pressures, was well implemented and adhered to. The levels of knowledge and self-reported adherence versus documented adherence regarding daily sedation interruption and spontaneous breathing trial demonstrated insufficient implementation of local guidelines. There was no affect on the outcome.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Jansson

Syrjälä

Ala‐Kokko

2019

American Journal of Infection Control

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“…Although we certainly agree with several of the points made in the letter and have endorsed them in our own articles, 1,2 we must correct the perception that we are recommending a fixed time for tracheotomy for all patients requiring prolonged mechanical ventilation. On the contrary, as we stated in our conclusions, 1 we are advocating for development of evidence-based guidelines around tracheotomy decision making that incorporate patient factors, provider factors, and institutional factors that currently influence treatment decision making, and to that end we are advocating for multi-institutional efforts to prospectively document these factors and study them to enable the question of timing to be properly answered.…”

Section: Letter To the Editormentioning

confidence: 90%

In response to late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients

et al. 2015

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“…procedure, relating increased mortality with the greater difficulty in ventilatory weaning when associated with late tracheostomies (up to 14 days after intubation) 12 . When performed in up to seven days, the length of ICU stay is reduced 13 .…”

Section: Rev Col Bras Cir 45(4):e1744mentioning

confidence: 99%

Elaboração de protocolo de condutas em traqueostomias no hospital referência de tratamento do câncer do Amazonas

Soares

Westphal

Lima

et al. 2018

Rev. Col. Bras. Cir.

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Objective: to create a multidisciplinary conducts manual for tracheostomies in adult and pediatric patients in the Amazonas State Oncology Control Center Foundation. Methods: we developed a protocol using the modified Delphi method, which consisted in the application of two series of questionnaires to 20 professionals of the unit. Results: thirteen professionals completed the two steps. In the first stage, there was consensus in 53 out of 92 questions (57.6%). The questions that obtained consensus formed the text of the second stage, divided into eight chapters and evaluated by marking the answers offered on a Linkert scale. All the chapters presented in the second stage obtained consensus, meaning that the sum of the answers "agree" and "fully agree" were above 70%. Conclusion: using the data obtained in the consensus, we elaborated a tracheostomy conduct protocol and a care guidelines manual for the patients and their caregivers.Keywords: Clinical Protocols. Tracheostomy. Medical Oncology. Hospitals. University. Head and Neck Surgery Service, Manaus, AM, A B S T R A C T -Amazonas Oncology Control Center Foundation (FCECON),

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Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients

Abstract: 4.

Cited by 12 publications

References 17 publications

Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

In response to late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients

Elaboração de protocolo de condutas em traqueostomias no hospital referência de tratamento do câncer do Amazonas

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