Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic

BACKGROUND Tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have conflicting findings regarding the optimal technique and its timing and benefits.AIM To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care hospital.METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years.Patients’demographic characteristics,severity of illness(APACHE II score),level of consciousness[Glasgow Coma Scale(GCS)],comorbidities,timing and type of tracheostomy procedure performed and outcome were recorded.We defined late as tracheostomy placement after 8 days or no tracheotomy.RESULTS Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at admission.Tracheostomy was performed in 115 patients,of whom 63 had early and 52 late procedures.Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy,however there were no significant statistical results(47.6%vs 36.5%,P=0.23)and(23.8%vs 19.2%,P=0.55)respectively.Regarding the method selected,early surgical tracheostomy(ST)was conducted in patients with maxillofacial injuries(50.0%vs 0.0%,P=0.033),whereas late surgical tracheostomy was selected for patients with goiter(44.4%vs 0.0%P=0.033).Patients with early tracheostomy spent significantly fewer days on mechanical ventilation(15.3±8.5 vs 22.8±9.6,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(PDT)vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission(62.5%vs 26.3%,P=0.004).ST was the method of choice in compromised airway(31.6%,vs 7.3%P=0.008).A large proportion of patients(88/115)with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.

Percutaneous dilatational tracheostomy for ICU patients with severe brain injury

Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.