Tracheostomy in Ventilator Dependent Trauma Patients: A Prospective, Randomized Intention-to-Treat Study

Barquist, Erik; Amortegui, Jose D.; Hallal, Ali; Giannotti, Giovanni; Whinney, Robb; Alzamel, Heythem; Macleod, Jana

doi:10.1097/01.ta.0000196743.37261.3f

Cited by 142 publications

(108 citation statements)

References 21 publications

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“…33,35,56,60 No mortality difference was found, and one of the 4 studies found a decrease in ventilator time for the early tracheostomy group. 61 …”

Section: Meta-analysis (4 Studies)mentioning

confidence: 98%

“…47,[56][57][58] Early tracheostomy was not associated with reduced short-term mortality (relative risk 0.86, 95% CI 0.65-1.13), long-term mortality (relative risk 0.84, 95% CI 0.68 -1.04), or VAP (relative risk 0.94, 95% CI 0.77-1.15) in critically ill subjects. The timing of the tracheotomy was not associated with changes in duration of mechanical ventilation, ICU or hospital stay, or complications.…”

Section: Meta-analysis (7 Studies)mentioning

confidence: 99%

“…This study was halted after the first interim analysis, with only 60 enrolled subjects. 56 Retrospective cohort studies demonstrated larger benefits to earlier tracheostomy. A single-center 5-y study of trauma subjects who received tracheostomy compared 29 subjects with early tracheostomy (within 7 d) to 107 patients with late tracheostomy (Ͼ 7 d) and found that early tracheostomy in trauma ICU patients was associated with shorter duration of mechanical ventilation and ICU stay, but no difference in hospital stay or ICU and hospital mortality.…”

Section: Traumamentioning

confidence: 99%

“…The sole prospective randomized trial within the past 10 y examining tracheostomy timing in trauma patients was performed by Barquist et al, 56 who compared trauma subjects who received a tracheostomy within 8 d of intubation versus subjects whose tracheostomies were delayed until after 28 d in a single-center trial. No differences in ventilator-free or ICU-free days at hospital days 20 and 30 and no differences in rates of VAP and hospital mortality were identified.…”

Section: Traumamentioning

confidence: 99%

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Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

2014

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“…33,35,56,60 No mortality difference was found, and one of the 4 studies found a decrease in ventilator time for the early tracheostomy group. 61 …”

Section: Meta-analysis (4 Studies)mentioning

confidence: 98%

Section: Meta-analysis (7 Studies)mentioning

confidence: 99%

Section: Traumamentioning

confidence: 99%

Section: Traumamentioning

confidence: 99%

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Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

2014

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“…Based on available evidence from randomized controlled trials, 11,12,13,14 there is no mortality benefit for early tracheostomy (≤ 10 days) as compared to the late tracheostomy (> 10days). However early tracheostomy was associated with more ventilator-free days, early weaning from mechanical ventilation and a shorter Intensive care unit length of stay.…”

Section: Discussionmentioning

confidence: 99%

Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy in intensive care unit: a prospective observational study

Azimee

Singh

2015

J. Soc. Anesth. Nep.

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Background: The aim of the study was to evaluate the safety of fiberoptic bronchoscope guided percutaneous dilatational tracheostomy performed in the intensive care unit.Methods: This was a prospective clinical study done on 30 critically ill patients in Intensive care unit. A puncture was made with 16G cannula at the second or third tracheal interspace which was confirmed by the fiberoptic bronchoscope. This was followed by insertion of guide wire through the cannula followed by insertion of the guiding catheter over the guide wire. The tract was enlarged with white single stage dilator to allow placement of a standard tracheostomy tube. The procedure was continuously monitored with the fiberoptic bronchoscope. Complications were noted during procedure and till patient’s stay in Intensive care unit.Results: The study included 18 (60%) male and 12 (40%) female patients. The mean age was 64.5±8 years. Percutaneous dilatational tracheostomy was done early (<10 days) in 10 (33.3%) patients and late (>10 days) in 20 (66.7%) patients. Fentanyl was used for the procedure in all the patients and among them 8 (26.6%) patients required injection rocuronium. Average procedure duration, from incision to suture for 30 patients was 12.6± 2 minutes. Indication for tracheostomy was weaning failure in 22 (73.3%) patients and airway maintenance in 8 (26.6%) patients. The mean duration patient remained on mechanical ventilation was 12.6 days and mean length of stay in critical care unit before shifting to ward was 7.6 days after tracheostomy. Acute postprocedure complications were transient bleed in four patients (13.3%), two (6.7%) had stomal bleeding, one (3%) had tracheal mucosa laceration and another (3%) had subcutaneous emphysema. No cases of stomal infection, pneumothorax, tracheal laceration, paratracheal insertion, pneumothorax and pneumomediastinum. There was no procedure-related mortality. Conclusion: Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy is safe and the method of choice for elective tracheostomy in the majority of intensive care patientsJournal of Society of Anesthesiologists of Nepal 2015; 2(2): 52-55

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Factors Associated With Survival Following Blunt Chest Trauma in Older Patients

et al. 2010

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In a large regional trauma cooperative, increasing age and Injury Severity Score were independent predictors of survival among older patients incurring traumatic RFs. Admission to high-volume trauma centers, preexisting congestive heart failure, and intubation added to mortality. Therapies associated with improved survival were patient-controlled analgesia and tracheostomy. Further regional cooperation should allow development of standard care practices for these challenging patients.

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Tracheostomy in Ventilator Dependent Trauma Patients: A Prospective, Randomized Intention-to-Treat Study

Cited by 142 publications

References 21 publications

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy in intensive care unit: a prospective observational study

Factors Associated With Survival Following Blunt Chest Trauma in Older Patients

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