2016, Number 4
Influence of tracheostomy in the weaning process
Language: Spanish
References: 23
Page: 4-11
PDF size: 119.37 Kb.
ABSTRACT
Introduction: the performing of tracheostomy before 10 days in critically ill patients with prolonged intubation significantly reduces the time of connection to mechanical ventilation and stay in the Intensive Care Unit; according to the Cuban experience it is advisable to carry it out early, especially in patients with traumatic brain injury, chronic obstructive pulmonary disease, or complications of the endotracheal tube (such as laryngeal stridor); however, complications related to failure in weaning require adequate solutions.Objective: to determine the influence of early and late tracheostomies in the weaning process of critical patients undergoing invasive mechanical ventilation.
Method: a descriptive observational study was carried out at the Intensive Care Unit of the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" from July 2014 to July 2015. The universe encompassed all patients admitted with mechanical ventilation, among whom a sample of 34 were selected, divided into two groups: one with early tracheostomy and one with late.
Results: the majority of the patients were female of white skin. There were no significant differences between the two groups in terms of ventilation time and length of stay in the Intensive Care Unit, but there were fewer complications and weaning failures among patients with early tracheostomy.
Conclusions: early tracheostomy in patients submitted to invasive mechanical ventilation has a lower rate of complications and the weaning process is less exposed to failures compared to late tracheostomy.
REFERENCES
Añón Elizalde JM. ¿Podemos predecir la duración del proceso de decanulación? Med Intens [Internet]. Nov 2012 [citado 16 Feb 2015];36(8):529-30. Disponible en: http://appswl.elsevier.es/publicaciones/item/pdf/watermark?idApp=WMIE&piiItem=S0210569 112001106&origen=medintensiva&web=medintensiva&urlApp=http://www.medintensiva.org &estadoItem=S300&idiomaItem=es
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 [Internet]. May 2013 [citado 12 Jun 2014];309(20):2121-9. Disponible en: http://www.ccm.pitt.edu/sites/default/files/ebm/early_vs_late_trach.pdf
Peñuelas O, Frutos-Vivar F, Gordo F, Apezteguía C, Restrepo MI, González M, et al. Desenlace de los enfermos traqueotomizados después de la reintubación. Med Intensiva [Internet]. Abr 2013 [citado 19 Mar 2014];37(3):142-8. Disponible en: http://appswl.elsevier.es/publicaciones/item/pdf/watermark?idApp=WMIE&piiItem=S0210569 112001416&origen=medintensiva&web=medintensiva&urlApp=http://www.medintensiva.org &estadoItem=S300&idiomaItem=es
Madero Pérez J, Vidal Tegedor B, Abizanda Campos R, Cubedo Bort M, Álvaro Sánchez R, Micó Gómez M. Traqueostomía percutánea en pacientes ventilados. Med Intensiva [Internet]. Abr 2007 [citado 12 Oct 2015];31(3):120-5. Disponible en: http://appswl.elsevier.es/publicaciones/item/pdf/watermark?idApp=WMIE&piiItem=13101487 &origen=medintensiva&web=medintensiva&urlApp=http://www.medintensiva.org&estadoIte m=S300&idiomaItem=es
Cochrane Database of Systematic Reviews, Issue 1, 2015. [base de datos en Internet]. Oxford: Update Software Ltd; 1998- [citado 12 Jun 2015]. Andriolo BNG, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients (Revisión Cochrane) CD007271. [aprox. 73 p.]. Disponible en: http://onlinelibrary.wiley.com/store/10.1002/14651858.CD007271.pub3/asset/CD007271_sta ndard.pdf?v=1&t=iwp6wnam&s=6c6e5357873471ee736e2cb82d5a87a59f05625b
Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs. late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA [Internet]. Abr 2010 [citado 12 Oct 2015];303(15):1483-9. Disponible en: http://jamanetwork.com/journals/jama/data/Journals/JAMA/4508/jce05003_1483_1489.pdf
Boynton JH, Hawkins K, Eastridge BJ, O’Keefe GE. Tracheostomy timing and the duration of weaning in patients with acute respiratory failure. Crit Care [Internet]. 2004 [citado 12 Oct 2015];8(4):R261-7. Disponible en: http://download.springer.com/static/pdf/594/art%253A10.1186%252Fcc2885.pdf?originUrl= http%3A%2F%2Fccforum.biomedcentral.com%2Farticle%2F10.1186%2Fcc2885&token2=exp =1481738881~acl=%2Fstatic%2Fpdf%2F594%2Fart%25253A10.1186%25252Fcc2885.pdf* ~hmac=d3916118863c88557698ce4e30b15b653df97067ff8c6946733856c085d1a829
Fernández R, Tizón AI, González J, Monedero P, García-Sánchez M, de la Torre MV, et al. Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis. Crit Care Med [Internet]. 2011 [citado 12 Oct 2015];39(10):2240-5. Disponible en: https://www.researchgate.net/profile/Rafael_Fernandez4/publication/51216758_Intensive_ca re_unit_discharge_to_the_ward_with_a_tracheostomy_cannula_as_a_risk_factor_for_mortalit y_A_prospective_multicenter_propensity_analysis/links/02e7e5239b1fbec39f000000.pdf
Hernández Martínez G, Ortiz Díaz-Miguel R, Pedrosa Guerrero A, Cuena Boy R, Vaquero Collado C, González Arenas P, et al. La indicación de la traqueotomía condiciona las variables predictoras del tiempo hasta la decanulación en pacientes críticos. Med Intens [Internet]. Nov 2012 [citado 12 Jun 2015];36(8):531-9. Disponible en: https://www.clinicalkey.es/service/content/pdf/watermarked/1-s2.0- S0210569112000575.pdf?locale=es_ES
Charry Segura D, Lozano Martínez V, Rodríguez Herrera Y, Rodríguez Medina C, Mogollón Mendoza P. Movilización temprana, duración de la ventilación mecánica y estancia en cuidados intensivos. Rev. Fac. Med. [Internet]. Dic 2013 [citado 27 Jul 2015];61(4):373-9. Disponible en: http://www.scielo.org.co/pdf/rfmun/v61n4/v61n4a6.pdf
Puga Torres MS, Pérez Martínez E, Pérez Pérez F, Gómez Sánchez A. Factores que influyen en la mortalidad del paciente ventilado en una unidad de cuidados intensivos. Rev Cub Med Int Emerg [Internet]. 2009 [citado 12 Ene 2015];8(2):1490-8. Disponible en: http://bvs.sld.cu/revistas/mie/vol8_4_09/mie02409.pdf
Siempos II, Ntaidou TK, Filippidis FT, Choi AM. Effect of early versus late or no tracheostomy on mortality of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Respir Med [Internet]. Feb 2015 [citado 26 Dic 2015];3(2):150-8. Disponible en: http://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600%2815%2900007-7.pdf
Yaghoobi S, Kayalha H, Ghafouri R, Yazdi Z, Khezri MB. Comparison of complications in percutaneous dilatational tracheostomy versus surgical tracheostomy. Glob J Health Sci [Internet]. Abr 2014 [citado 26 Feb 2015];6(4):221-5. Disponible en: http://www.ccsenet.org/journal/index.php/gjhs/article/viewFile/33563/20379