medigraphic.com
ISSN 2007-6053 (Print)
Órgano oficial de difusión de los Hospitales Regionales de Alta Especialidad (HRAE)

2015, Number 4

<< Back Next >>

Evid Med Invest Salud 2015; 8 (4)

Experience in the practice of tracheostomy in critically ill patients in the Intensive Care Unit of the Regional Hospital of High Speciality of Oaxaca

Vásquez-Revilla HR, Revilla-Rodríguez E, Gualberto-González C, Terrazas LV

Language: Spanish
References: 15
Page: 167-171
PDF size: 301.39 Kb.


ABSTRACT

Introduction: Controversy exists regarding the timing and the technique used to perform tracheostomy in critically ill patients. Objective: To describe the experience of the Intensive Care Unit (ICU) of the Regional Hospital of High Speciality of Oaxaca (HRAEO) in performing tracheostomies in critically ill patients. Material and methods: An ambispective, observational and descriptive study was conducted in individuals admitted to the ICU of the HRAEO from January 1, 2012 to June 30, 2014. Results: A total of 53 patients were included; we found significant differences between early and late tracheostomy regarding the days of mechanical ventilation (19.9 versus 22.6, p = 0.027), ICU length of stay (9.2 versus 19.4, p ‹ 0.05) and ventilator-associated pneumonia (35.3 versus 63.2%, p = 0.05); in terms of length of hospital stay (32.4 versus 36.0, p = 0.565), ICU mortality (20.6 versus 15.8%, p = 0.669) and hospital mortality (29.4 versus 52.6%, p = 0.094), no statistically significant difference was observed. Percutaneous and open techniques were analyzed in terms of days of mechanical ventilation (22 versus 19.4, p = 0.66), length of stay in the ICU (12.7 versus 13.4, p = 0.81), length of hospital stay (35.6 versus 26.2, p analyzed = 0.207), ventilator-associated pneumonia (39.6 versus 5.7%, p = 0.178), ICU mortality (11.3 versus 7.5%, p = 0.096) and hospital mortality (28.3 versus 9.4%, p = 0.553); no significant difference was found. Conclusions: Early tracheostomy is associated with reduced duration of mechanical ventilation, fewer days in the ICU and lower frequency of ventilator-associated pneumonia; there is no significant difference in ICU and hospital mortality.


REFERENCES

  1. Romero C, Cornejo R, Tobar E, Llanos O, Gálvez R, Espinoza M et al. Traqueostomía en el paciente crítico. Rev Hosp Clín Univ Chile. 2009; 20: 148-159.

  2. Zgoda M, Berger R. Tracheostomy in the critically ill patient: who, when and how? Clin Pulm Med. 2006; 13: 1-10.

  3. Cox C, Carson S, Holmes G, Howard A, Carey T. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med. 2004; 32: 2219-2226.

  4. Santos P, Afrassiabi A, Weymuller E. Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg. 1994; 111: 453-459.

  5. Pérez E, Yáñez R, Avilés E, Alarcón C, Weisse O, Curi M et al. Traqueostomía percutánea en la Unidad de Cuidados Intensivos. Rev Chil Cir. 2011; 63: 356-360.

  6. Möller MG, Slaikeu JD, Bonelli P, Davis AT, Hoogeboom JE, Bonnell BW. Early tracheostomy versus late tracheostomy in the surgical intensive care unit. The Am J Surg. 2005; 189: 293-296.

  7. Kollef M, Ahrens T, Shannon W. Clinical predictors an outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med. 1999; 27: 1714-1720.

  8. Freeman B, Boreck I, Coopersmith C, Buchman T. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med. 2005; 33: 2513-2520.

  9. Arabi Y, Haddad S, Shirawi N, Al Shimemeri A. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Critical Care. 2004; 8: 347-352.

  10. Rumbak M, Newton M, Truncale T, Schwartz S, Adams J, Hazard P. A prospective, randomized, study comparing early percutaneous dilation tracheostomy to prolonged translaryngeal intubation (delayed tracheostomy) in critically ill medical patients. Crit Care Med. 2004; 32: 1689-1694.

  11. Trouillet JL, Luyt CE, Guiguet M, Ouattara A, Vaissier E, Makri R et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med. 2011; 154: 373-383.

  12. Freeman B, Morris P. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012; 40: 2890-2896.

  13. Wang F, Wu Y, Bo L, Lou J, Zhu J, Chen F et al. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011; 140 (6): 1456-1465.

  14. Young D, Harrison DA, Cuthbertson BH, Rowan K. Effect of early vs. late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013; 309 (20): 2121-2129.

  15. Maza G, Arzate J, Kaneko F. Traqueostomía dilatacional percutánea como modalidad de manejo de la vía aérea en la unidad de terapia intensiva de un hospital militar. Rev Asoc Mex Med Crit y Ter Int. 2002; 16 (2): 48-52.




2020     |     www.medigraphic.com