Introduction
Materials and methods
Results
Study respondents
Response rate | Statistics | |||
---|---|---|---|---|
Total | Europe | Outside Europe | ||
Valid respondents | 281 (100 %) | 208/281 (74 %) | 73/281 (26 %) | - |
Main specialty area | ||||
- Intensive care | 202/281 (71.9 %) | 147/208 (70.7 %) | 55/73 (75.3 %) | |
- Anesthesiology | 63/281 (22.4 %) | 51/208 (24.5 %) | 12/73 (16.4 %) | |
- Pulmonology | 5/281 (1.8 %) | 3/208 (1.4 %) | 2/73 (2.7 %) |
X
2 = 10.810 |
- Cardiology | 2/281 (0.7 %) | 0 | 2/73 (2.7 %) |
P = 0.094 |
- Neurology | 1/281 (0.4 %) | 1/208 (0.5 %) | 0 | |
- Surgery | 2/281 (0.7 %) | 1/208 (0.5 %) | 1/73 (1.4 %) | |
- Other | 6/281 (2.1 %) | 3/208 (1.4 %) | 1/73 (1.4 %) | |
Type of institution | ||||
- Public hospital | 128/281 (45.6 %) | 105/208 (50.5 %) | 23/73 (31.5 %) |
X
2 = 52.573 |
- Private hospital | 33/281 (11.7 %) | 9/208 (4.3 %) | 24/73 (32.9 %) |
P = 0.000 |
- University hospital | 120/281 (42.7 %) | 94/208 (45.2 %) | 26/73 (35.6 %) | |
Type of intensive care | ||||
- Cardiac | 9/281 (3.2 %) | 8/208 (3.8 %) | 1/73 (3.8 %) | |
- Mixed | 206/281 (73.3 %) | 154/208 (74 %) | 52/73 (71.2 %) |
X
2 = 23.108 |
- Medical | 22/281 (7.8 %) | 9/208 (4.3 %) | 13/73 (17.8 %) |
P = 0.000 |
- Neurological | 13/281 (4.6 %) | 12/208 (5.8 %) | 1/73 (1.4 %) | |
- Surgical | 31/281 (11 %) | 25/208 (12 %) | 6/73 (8.2 %) | |
Number of ICU beds | ||||
- ≤ 5 | 8/281 (2.8 %) | 7/208 (3.4 %) | 1/73 (1.4 %) | |
- 6−10 | 101/281 (35.9 %) | 84/208 (40.4 %) | 17/73 (23.3 %) |
X
2 = 14.942 |
- 11−15 | 61/281 (21.7 %) | 44/208 (21.2 %) | 17/73 (23.3 %) |
P = 0.011 |
- 16−20 | 49/281 (17.4 %) | 32/208 (15.4 %) | 17/73 (23.3 %) | |
- ≥21 | 62/281 (22.1 %) | 41/208 (19.7 %) | 21/73 (28.8 %) | |
Number of patients/years admitted in ICU | ||||
- ≤300 | 39/281 (13.9 %) | 31/208 (14.9 %) | 8/73 (11 %) |
X
2 = 2.517 |
- 301−600 | 98/281 (34.9 %) | 71/208 (34.1 %) | 27/73 (37 %) |
P = 0.472 |
- 601−999 | 63/281 (22.4 %) | 44/208 (21.2 %) | 19/73 (26 %) | |
- ≥1000 | 81/281 (28.8 %) | 62/208 (29.8 %) | 19/7 (26 %) | |
Different techniques performed | ||||
- one | 99/281 (35.2 %) | 63/208 (30.3 %) | 36/73 (49.3 %) | |
- two | 14/281 (49.8 %) | 109/208 (52.4 %) | 31/73 (42.5 %) |
X
2 = 19.708 |
- three | 31/281 (11 %) | 26/208 (12.5 %) | 5/73 (6.8 %) |
P = 0.001 |
- four | 7/281 (2.5 %) | 7/208 (3.4 %) | 0 | |
- five | 2/281 (0.7 %) | 2/208 (1 %) | 0 | |
- six | 2/281 (0.7 %) | 1/208 (0.5 %) | 1/73 (1.4 %) |
Tracheostomy
Informed consent
Percutaneous dilatational tracheostomy (PDT)
Response rate | Statistics | |||
---|---|---|---|---|
Total | Europe | Outside Europe | ||
Who performed PDT in ICU | ||||
- One or more intensivists | 208/281 (74 %) | 166/208 (79.8 %) | 42/73 (57.5 %) | |
- Intensivist with ENT specialists | 16/281 (5.7 %) | 10/208 (4.8 %) | 6/73 (8.2 %) | |
- Intensivist with general surgeon | 6/281 (2.1 %) | 1/208 (0.5 %) | 5/73 (6.8 %) |
X
2 = 51.732 |
- Intensivist with other surgeon | 8/281 (2.8 %) | 5/208 (2.4 %) | 3/73 (4.1 %) |
P = 0.000 |
- Anesthesiologist | 18/281 (6.4 %) | 17/208 8.2 %) | 1/73 (1.4 %) | |
- ENT specialists | 15/281 (5.3 %) | 7/208 (3.4 %) | 8/73 (11 %) | |
- General surgeon | 7/281 (2.5 %) | 1/208 (0.5 %) | 6/73 (8.2 %) | |
- Another surgeon | 3/281 (1.1 %) | 1/208 (0.5 %) | 2/73 (2.7 %) | |
Most frequent indication | ||||
- Prolonged mechanical ventilation | 151/281 (53.7 %) | 107/208(51.4 %) | 44/73 (60.3 %) | |
- Difficult/prolonged weaning | 68/281 (24.2 %) | 55/208 (26.4 %) | 13/73 (17.8 %) |
X
2 = 9.039 |
- Neurocritical disease (medical, disease, surgical or trauma involving the neurologic system) | 41/281 (14.6 %) | 32/208 (15.4 %) | 9/73 (12.3 %) |
P = 0.171 |
- Inability to perform airway protection | 12/281 (4.3 %) | 8/208 (3.8 %) | 4/73 (5.5 %) | |
- Inability to cough and swallow | 5/281 (1.8 %) | 4/208 (1.9 %) | 1/73 (1.4 %) | |
- Improvement of patient respiratory mechanics | 3/281 (1.1 %) | 1/208 (0.5 %) | 2/73 (2.7 %) | |
- Copious secretions | 1/281 (0.4 %) | 1/208 (0.5 %) | 0 | |
Most frequent timing | ||||
- <7days | 55/281 (19.6 %) | 47/208 (22.1 %) | 9/73 (12.3 %) | |
- 7–15 days | 153/281 (54.4 %) | 108/208 (51.9 %) | 45/73 (61.6 %) |
X
2 = 9.707 |
- 15–21 days | 58/281 (20.6 %) | 43/208 (20.7 %) | 15/73 (20.5 %) |
P = 0.046 |
- 21–30 days | 11/281 (3.9 %) | 7/208 (3.4 %) | 4/73 (5.5 %) | |
- >30 days | 4/281 (1.4 %) | 4/208 (1.9 %) | 0 | |
Mechanical ventilation mostly used | ||||
- Volume control ventilation | 119/281 (42.3 %) | 84/208 (40.4 %) | 35/73 (47.9 %) | |
- Pressure control ventilation | 102/281 (36.3) | 75/208 (36.1 %) | 27/73 (37 %) | |
- Minute volume/adaptive support ventilation | 13/281 (4.6 %) | 12/208 (5.8 %) | 1/73 (1.4 %) |
X
2 = 15.504 |
- Bi-level airway pressure | 34/281 (12.1 %) | 30/208 (14.4 %) | 4/73 (5.5 %) |
P = 0.004 |
- Other | 13/281 (4.6 %) | 7/208 (3.4 %) | 6/73 (8.2 %) | |
Sedation-analgesia-neuromuscular blocking protocol provided | ||||
- Yes | 221/278 (79.5 %) | 163/207 (78.7 %) | 58/71 (81.7 %) |
X
2 = 0.456 |
- No | 57/278 (20.5 %) | 44/207 (21.3 %) | 13/71 (18.3 %) |
P = 0.500 |
Local anesthesia provided | ||||
- Yes | 179/276 (64.9 %) | 124/206 (60.2 %) | 55/70 (78.6 %) |
X
2 = 12.859 |
- No | 97/276 (35.1 %) | 82/206 (39.8 %) | 15/70 (21.4 %) |
P = 0.000 |
Bronchoscopy used during PDT | ||||
- Yes | 180/260 (69.2 %) | 153/194 (78.9 %) | 39/66 (59.1 %) |
X
2 = 48.827 |
- No | 80/260 (30.8 %) | 41/194 (21.1 %) | 27/66 (40.9 %) |
P = 0.000 |
Bronchoscopy during PDT performed | ||||
- Through ETT in place | 232/267 (86.9 %) | 176/201(87.6 %) | 56/66 (84.8 %) | |
- Replacement with larger ETT | 16/267 (6 %) | 12/201 (6 %) | 4/66 (6.1 %) |
X
2 = 0.807 |
- Replacement with smaller ETT | 3/267 (1.1 %) | 2/201 (1 %) | 1/66 (1.5 %) |
P = 0.848 |
- Through LMA | 16/267 (6 %) | 11/201 (5.5 %) | 5/66 (7.6 %) | |
- Diameter of bronchoscope used | ||||
- 3–4 mm | 40/220 (18.2 %) | 34/169 (20.2 %) | 6/52 (11.5 %) | |
- 5 mm | 86/220 (39.1 %) | 72/169 (42.9 %) | 14/52 (26.9 %) |
X
2 = 17.268 |
- 6 mm | 65/220 (29.5 %) | 45/169 (26.8 %) | 20/52 (38.5 %) |
P = 0.001 |
- 7 mm | 29/220 (13.2 %) | 17/169 (10.1 %) | 12/52 (23.1 %) | |
- ≥8 mm | 0 | 0 | 0 | |
Bronchoscope was chosen | ||||
- According to availability in ICU | 143/224 (63.8 %) | 110/171 (64.3 %) | 33/53 (62.3 %) | |
- According the size of ETT in place | 51/224 (22.8 %) | 37/171 (21.6 %) | 14/53 (26.4 %) |
X
2 = 1.051 |
- Always with the smallest diameter | 30/224 (13.4 %) | 24/171 (14 %) | 6/53 (11.3 %) |
P = 0.591 |
- Randomly without assessment | 0 | 0 | 0 | |
Neck ultrasound for PDT used | ||||
- To guide needle, dilator and cannula placement | 25/118 (21.2 %) | 18/95 (18.9 %) | 7/23 (30.4 %) |
X
2 = 5.966 |
- In suspected at-risk structure | 81/118 (68.6 %) | 69/95 (72.6 %) | 12/23 (52.2 %) |
P = 0.051 |
- Both together | 127118 (10.2 %) | 8/95 (8.4 %) | 4/23 (17.4 %) | |
Tracheostomy tube used | ||||
- Cuffed | 118/257 (45.9 %) | 89/194 (45.9 %) | 29/63 (46 %) | |
- Cuffed with inner cannula | 94/257 (36.6 %) | 75/194 (38.7 %) | 19/63 (30.2 %) |
X
2 = 6.568 |
- Both | 43/257 (16.7 %) | 28/194 (14.4 %) | 15/63 (23.8 %) |
P = 0.087 |
- Other | 2/257 (0.8 %) | 2/194 (1 %) | 0 |
Surgical tracheostomy
Response rate | Statistics | |||
---|---|---|---|---|
Total | Europe | Outside Europe | ||
Where ST was performed | ||||
- ICU | 106/281 (37.7 %) | 74/208 (35.6 %) | 32/73 (43.8 %) |
X
2 = 3.220 |
- Operating room | 166/281 (59.1 %) | 128/208 (61.5 %) | 38/73 (52.1 %) |
P = 0.200 |
- Other | 9/281 (3.2 %) | 6/208 (2.9 %) | 3/73 (4.1 %) | |
Critically ill patients receiving Tracheostomy in operating room | 2797 (15.6 %)* | 2022 (15.2 %) | 775 (16.2 %) |
P = 0.642 |
Who performed ST in operating room | ||||
- Anesthesiologist | 2/281 (0.7 %) | 2/208 (1 %) | 0 | |
- Intensivist | 7/281 (2.5 %) | 6/208 (3 %) | 1/73 (1.4 %) | |
- ENT specialist | 165/281 (58.7 %) | 113/208 (56.8 %) | 52/73 (73.2 %) | |
- General surgeon | 42/281 (14.9 %) | 29/208 (14.6 %) | 13/73 (18.3 %) |
X
2 = 28.302 |
- Thoracic surgeon | 17/281 (6 %) | 15/208 (7.5 %) | 2/73 (2.8 %) |
P = 0.000 |
- Plastic surgeon | 1/281 (0.4 %) | 0 | 1/73 (1.4 %) | |
- Maxillofacial surgeon | 28/281 (10 %) | 26/208 (13.1 %) | 2/73 (2.8 %) | |
- Other | 8/281 (2.8 %) | 8/208 (4 %) | 0 | |
Why ST was chosen | ||||
- Insufficient expertise in PDT | 22/281 (7.8 %) | 9/208 (4.3 %) | 13/73 (17.8 %) | |
- Reserved for patients with predicted difficult PDT | 187/281 (70.1 %) | 153/208 (73.6 %) | 44/73 (60.3 %) |
X
2 = 20.207 |
- Predicted need for prolonged tracheostomy | 23/281 (8.2 %) | 19/208 (9.1 %) | 4/73 (5.5 %) |
P = 0.000 |
- Other | 39/281 (13.9 %) | 27/208 (13 %) | 12/73 (16.4 %) |
Complications
Response rate | Statistics | |||
---|---|---|---|---|
Total | Europe | Outside Europe | ||
Most frequent intraprocedural complication | ||||
- Puncture posterior tracheal wall | 2/257 (0.8 %) | 2/194 (1 %) | 0 | |
- Puncture ETT | 52/257 (20.2 %) | 47/194 (24.2 %) | 5/63 (7.9 %) | |
- Accidental extubation | 17/257 (6.6 %) | 15/194 (7.7 %) | 2/63 (3.2 %) | |
- Difficult cannula placement | 47/257 (18.3 %) | 34/194 (17.5 %) | 13/63 (20.6 %) | |
- Stoma not adequate | 6/257 (2.3 %) | 1/194 (0.5 %) | 5/63 (7.9 %) |
X
2 = 36.296 |
- False passage | 4/257 (1.6 %) | 2/194 (1 %) | 2/63 (3.2 %) |
P = 0.000 |
- Convert the procedure | 4/257 (1.6 %) | 2/194 (1 %) | 2/63 (3.2 %) | |
- Bleeding controlled by compression | 89/257 (31.7 %) | 63/194 (32.5 %) | 26/63 (41.3 %) | |
- Bleeding requiring exploration | 1/257 (0.4 %) | 1/194 (0.5 %) | 0 | |
- Desaturation (<90 %) | 16/257 (6.2 %) | 11/194 (5.7 %) | 5/63 (7.9 %) | |
- Pneumothorax | 0 | 0 | 0 | |
- Emphysema | 1/257 (0.4 %) | 1/194 (0.5 %) | 0 | |
- Other | 18/257 (7 %) | 15/194 (7.7 %) | 3/63 (4.8 %) | |
Most frequent early complication | ||||
- Puncture posterior tracheal wall | 1/257 (0.4 %) | 1/194 (0.5 %) | 0 | |
- Puncture ETT | 16/257 (6.2 %) | 14/194 (7.2 %) | 2/63 (3.2 %) | |
- Accidental extubation | 3/257 (1.2 %) | 3/194 (1.5 %) | 0 | |
- Difficult cannula placement | 13/257 (5.1 %) | 10/194 (5.2 %) | 3/63 (4.8 %) | |
- Stoma not adequate | 2/257 (0.8 %) | 0 | 2/63 (3.2 %) |
X
2 = 37.981 |
- False passage | 2/257 (0.8 %) | 2/194 (1 %) | 0 |
P = 0.000 |
- Convert the procedure | 2/257 (0.8 %) | 2/194 (1 %) | 0 | |
- Bleeding controlled by compression | 163/257 (63.4 %) | 114/194 (58.8 %) | 49/63 (77.8 %) | |
- Bleeding requiring exploration | 9/257 (3.5 %) | 9/194 (4.6 %) | 0 | |
- Desaturation (<90 %) | 11/257 (4.3 %) | 10/194 (5.2 %) | 1/63 (1.6 %) | |
- Pneumothorax | 1/257 (0.4 %) | 1/194 (0.5 %) | 0 | |
- Emphysema | 8/257 (3.1 %) | 4/194 (2.1 %) | 4/63 (6.3 %) | |
- Other | 26/257 (10.1 %) | 24/194 (12.4 %) | 2/63 (3.2 %) | |
Most frequent late complication | ||||
- Bleeding controlled by compression | 44/257 (17.1 %) | 35/194 (18 %) | 9/63 (14.3 %) | |
- Bleeding requiring exploration | 15/257 (5.8 %) | 13/194 (6.7 %) | 2/63 (3.2 %) |
X
2 = 3.555 |
- Stoma infection/inflammation | 85/257 (33.1 %) | 61/194 (31.4) | 24/63 (38.1 %) |
P = 0.470 |
- Cannula extraction/malpositioning | 54/257 (21 %) | 40/194 (20.6 %) | 14/63 (22.2 %) | |
- Other | 59/257 (23 %) | 45/194 (23.2 %) | 14/63 (22.2 %) |
Discussion
Limitations
Conclusions
Key messages
-
Percutaneous dilatational tracheostomy is one of the most frequent procedure performed in the intensive care unit
-
Percutaneous dilatational tracheostomy is used worldwide in critically ill patients, without clinical guidelines to suggest the best practice
-
This survey represents the first global picture of current practices in performing tracheostomy
-
This survey demonstrates considerable international variation in practice, suggesting a need for greater standardization of approaches to tracheostomy insertion