Optimal timing of tracheostomy after trauma without associated head injury

Keenan, Jeffrey E.; Gulack, Brian C.; Nussbaum, Daniel P.; Green, Cindy L.; Vaslef, Steven N.; Shapiro, Mark L.; Scarborough, John

doi:10.1016/j.jss.2015.03.072

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…Regarding complications following tracheostomy, only pneumonia was frequently present, with similar rates as reported by previous studies [ 13 , 26 ]. No other procedural complications occurred, demonstrating the safety of tracheostomy as an airway patency management procedure, even in presumed complex patients.…”

Section: Discussionsupporting

confidence: 86%

Surgical airway procedures in emergency surgical patients: Results of what has become a back‐up procedure

2021

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Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.

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Section: Discussionsupporting

confidence: 86%

Surgical airway procedures in emergency surgical patients: Results of what has become a back‐up procedure

2021

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“…Hsu et al [26] also demonstrated that tracheostomy after 21 days from intubation was associated with weaning failure and ICU mortality. Meanwhile, Keenan et al [13] reported that tracheostomy within 10 days after intubation was related to mortality in trauma patients without head injury. These findings make it difficult to confine the specific time limit for tracheostomy in trauma patients, especially due to numerous confounding variables associated with the outcomes.…”

Section: Discussionmentioning

confidence: 99%

Early Versus Late Tracheostomy in Trauma Patients: A Propensity‐Matched Cohort Study of 5 Years’ Data at a Single Institution in Korea

et al. 2018

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“…In den EAST-Guidelines von 2009 [49] Seither wurden zahlreiche weitere Studien (allerdings alle retrospektiv oder Registerstudien) publiziert, die ein uneinheitliches Bild hinterlassen. Während in der Mehrzahl der Untersuchungen (beispielhaft bei Patienten mit Trauma [50] oder Schädel-Hirn-Trauma [51,52]) eine frühe Tracheotomie zu weniger Pneumonien und einer verkürzten Beatmungsdauer und Intensivliegedauer führten, resultierte in anderen Analysen sogar eine erhöhte Sterblichkeit [53,54]. Auch die Aussagen bezüglich der Sicherheit einer perkutanen Dilatationstracheotomie bei Patienten mit Schädel-Hirn-Trauma und ob diese zu einem relevanten Anstieg des intrakraniellen Druckes führt [55] oder nicht [56], sind widersprüchlich.…”

Section: Tracheotomieunclassified

Intensivbehandlung des polytraumatisierten Patienten

Waydhas¹,

Hamsen²

2017

Orthopädie und Unfallchirurgie up2date

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Optimal timing of tracheostomy after trauma without associated head injury

Cited by 9 publications

References 31 publications

Surgical airway procedures in emergency surgical patients: Results of what has become a back‐up procedure

Surgical airway procedures in emergency surgical patients: Results of what has become a back‐up procedure

Early Versus Late Tracheostomy in Trauma Patients: A Propensity‐Matched Cohort Study of 5 Years’ Data at a Single Institution in Korea

Intensivbehandlung des polytraumatisierten Patienten

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