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25.07.2022 | Original Article

Comparative evaluation of early versus late tracheostomy for reduction of the length of ICU stay, incidence of nosocomial pneumonias, risk of laryngeal injury and mortality of mechanically ventilated patients at a Tertiary Care Hospital in Western India

verfasst von: Gati Shah, Chinmayee Joshi, Bela J. Prajapati, Nandini J Gupta

Erschienen in: Indian Journal of Otolaryngology and Head & Neck Surgery | Sonderheft 3/2022

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Abstract

Introduction

Tracheostomy is a very common procedure performed in ICU as it offers significant advantages over prolonged endotracheal intubation. It facilitates weaning by decreasing the work of breathing in patients with limited reserve by decreasing the dead space area, decreases the requirement for sedation, and may allow for earlier patient mobilization, feeding, and physical and occupational therapy as compared to prolonged intubation along with lesser oral and oropharyngeal ulcerations, improves pulmonary toileting, and lowers incidence of pulmonary infections. Tracheostomy, however, is not devoid of risks. Complications may include hemorrhage, stoma infections and granulations, pneumothorax, subcutaneous emphysema, tracheal stenosis, tracheomalacia, and rarely death. Hence, performance of tracheostomy should be considerate to outweigh benefit-risk ratio.

Aims and objectives

To evaluate the early versus late tracheostomy for reduction of the length of ICU stay, incidence of nosocomial pneumonias, risk of laryngeal injury and mortality of mechanically ventilated patients.

Materials and methods

We conducted a retrospective study from May, 2019 to April, 2021 of patients being tracheostomized in medical ICU at Civil Hospital, Ahmedabad, who were previously intubated endotracheally and were on mechanical ventilation. The decision to tracheostomize would be taken by physicians in their routine rounds in ICU.

Results

Incidence of endolaryngeal complications like laryngotracheal stenosis, stomal granulations, fistula as well as nosocomial infections have lower incidence in early tracheostomy as compared to with late. Mortality remains same in both the groups as well as hospital and ICU stay.
Literatur
1.
Zurück zum Zitat Davis K Jr, Campbell RS, Johannigman JA, Valente JF, Branson RD (1999) Changes in respiratory mechanics after tracheostomy. Arch Surg 134(1):59–62CrossRef Davis K Jr, Campbell RS, Johannigman JA, Valente JF, Branson RD (1999) Changes in respiratory mechanics after tracheostomy. Arch Surg 134(1):59–62CrossRef
2.
Zurück zum Zitat Diehl J-L, El Atrous S, Touchard D, Lemaire F, Brochard L (1999) Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respiratory Crit Care Med 159(2):383–388CrossRef Diehl J-L, El Atrous S, Touchard D, Lemaire F, Brochard L (1999) Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respiratory Crit Care Med 159(2):383–388CrossRef
3.
Zurück zum Zitat Nieszkowska A, Combes A, Luyt CE et al (2005) Impact of tracheotomy on sedative administration, sedation level, and comfort ofmechanically ventilated intensive care unit patients. Crit Care Med 33(11):2527–2533CrossRef Nieszkowska A, Combes A, Luyt CE et al (2005) Impact of tracheotomy on sedative administration, sedation level, and comfort ofmechanically ventilated intensive care unit patients. Crit Care Med 33(11):2527–2533CrossRef
4.
Zurück zum Zitat Freeman BD, Morris PE (2012) Tracheostomy practice in adults with acute respiratory failure. Crit CareMedicine 40(10):2890–2896 Freeman BD, Morris PE (2012) Tracheostomy practice in adults with acute respiratory failure. Crit CareMedicine 40(10):2890–2896
5.
Zurück zum Zitat Plummer A, Gracey D (1989) Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 96(1):178–1780 Plummer A, Gracey D (1989) Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 96(1):178–1780
6.
Zurück zum Zitat Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit CareMedicine 32(8):1689–1694 Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit CareMedicine 32(8):1689–1694
7.
Zurück zum Zitat Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA (2008) The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 36(9):2547–2557CrossRef Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA (2008) The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 36(9):2547–2557CrossRef
8.
Zurück zum Zitat Young D, Harrison DA, Cuthbertson BH (2013) Rowan,“Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. J AmericanMedical Association 309(20):2121–2129CrossRef Young D, Harrison DA, Cuthbertson BH (2013) Rowan,“Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. J AmericanMedical Association 309(20):2121–2129CrossRef
9.
Zurück zum Zitat Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation. Chest 96:877–884CrossRef Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation. Chest 96:877–884CrossRef
10.
Zurück zum Zitat Whited RE (1984) A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 94:367–377CrossRef Whited RE (1984) A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 94:367–377CrossRef
11.
Zurück zum Zitat Horan TCG, Gaynes RP (2004) “Surveillance of nosocomial infections,” in Hospital Epidemiology and Infection Control, C. G.Mayhall, Ed., pp. 1659–1702, LippincottWilliams &Wilkins, Philadelphia, Pa, USA, 3rd edition, Horan TCG, Gaynes RP (2004) “Surveillance of nosocomial infections,” in Hospital Epidemiology and Infection Control, C. G.Mayhall, Ed., pp. 1659–1702, LippincottWilliams &Wilkins, Philadelphia, Pa, USA, 3rd edition,
13.
Zurück zum Zitat M¨oller MG, Slaikeu JD, Bonelli P, Davis AT, Hoogeboom JE, Bonnell BW (2005) Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg 189(3):293–296CrossRef M¨oller MG, Slaikeu JD, Bonelli P, Davis AT, Hoogeboom JE, Bonnell BW (2005) Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg 189(3):293–296CrossRef
14.
Zurück zum Zitat Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32(8):1689–1694CrossRef Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32(8):1689–1694CrossRef
15.
Zurück zum Zitat [14] DC, Scales D, Thiruchelvam A, Kiss, Redelmeier DA (2008) The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 36(9):2547–2557 [14] DC, Scales D, Thiruchelvam A, Kiss, Redelmeier DA (2008) The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 36(9):2547–2557
16.
Zurück zum Zitat Young D, Harrison DA, Cuthbertson BH, Rowan K (2013) Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 309(20):2121–2129CrossRef Young D, Harrison DA, Cuthbertson BH, Rowan K (2013) Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 309(20):2121–2129CrossRef
17.
Zurück zum Zitat Curry SD, Rowan PJ (2020 Feb) Laryngotracheal stenosis in early vs late tracheostomy: a systematic review. Otolaryngology–Head and Neck Surgery 162(2):160–167 Curry SD, Rowan PJ (2020 Feb) Laryngotracheal stenosis in early vs late tracheostomy: a systematic review. Otolaryngology–Head and Neck Surgery 162(2):160–167
Metadaten
Titel
Comparative evaluation of early versus late tracheostomy for reduction of the length of ICU stay, incidence of nosocomial pneumonias, risk of laryngeal injury and mortality of mechanically ventilated patients at a Tertiary Care Hospital in Western India
verfasst von
Gati Shah
Chinmayee Joshi
Bela J. Prajapati
Nandini J Gupta
Publikationsdatum
25.07.2022
Verlag
Springer India
Erschienen in
Indian Journal of Otolaryngology and Head & Neck Surgery / Ausgabe Sonderheft 3/2022
Print ISSN: 2231-3796
Elektronische ISSN: 0973-7707
DOI
https://doi.org/10.1007/s12070-022-03115-z

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