Percutaneous tracheostomy procedures and patient results in a tertiary intensive care unit: A single-center experience

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

The ideal timing for tracheostomy in patients undergoing prolonged mechanical ventilation (MV) in the intensive care unit (ICU) remains controversial. The present study aimed to provide an overview of the timing of percutaneous dilation tracheostomy performed in the ICU over a 5-year period, and the effect of this procedure on 28-day mortality. The study included patients who underwent early (≤14 days) (n = 112) and late (>14 days) (n = 171) tracheostomy during their follow-up in the ICU between 2018 and 2023. It is a single-center retrospective study. The diagnoses, comorbidities, MV duration, tracheostomy timing, tracheostomy indications, tracheostomy complications, ICU length of stay, hospital length of stay, extubation attempts, mortality, time to decannulation, and ICU discharge location were determined in both tracheostomy groups and compared. The effect of tracheostomy timing on mortality risk was evaluated using multivariate Cox regression analyses. In the early tracheostomy group, MV duration, ICU hospitalization, hospital stay, and extubation attempt were lower. The 28-day intensive care mortality rates were not statistically different between the early and late tracheostomy groups. Multivariate regression analysis showed that mortality risk increased with prolonged MV and tracheostomy complications. In terms of mortality rates in palliative care, mortality in the late tracheostomy group was significantly lower than in the early tracheostomy group. The study demonstrated that the timing of tracheostomy in the ICU had no effect on mortality risk in multivariate analysis. We believe that time is not the only limiting factor when considering tracheostomy and prospective randomized studies are needed.

Related collections

Most cited references 42

Record: found
Abstract: found
Article: not found

Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial.

Duncan Young, David A Harrison, Brian H Cuthbertson … (2013)

Tracheostomy is a widely used intervention in adult critical care units. There is little evidence to guide clinicians regarding the optimal timing for this procedure. To test whether early vs late tracheostomy would be associated with lower mortality in adult patients requiring mechanical ventilation in critical care units. An open multicentered randomized clinical trial conducted between 2004 and 2011 involving 70 adult general and 2 cardiothoracic critical care units in 13 university and 59 nonuniversity hospitals in the United Kingdom. Of 1032 eligible patients, 909 adult patients breathing with the aid of mechanical ventilation for less than 4 days and identified by the treating physician as likely to require at least 7 more days of mechanical ventilation. Patients were randomized 1:1 to early tracheostomy (within 4 days) or late tracheostomy (after 10 days if still indicated). The primary outcome measure was 30-day mortality and the analysis was by intention to treat. Of the 455 patients assigned to early tracheostomy, 91.9% (95% CI, 89.0%-94.1%) received a tracheostomy and of 454 assigned to late tracheostomy, 44.9% (95% CI, 40.4%-49.5%) received a tracheostomy. All-cause mortality 30 days after randomization was 30.8% (95% CI, 26.7%-35.2%) in the early and 31.5% (95% CI, 27.3%-35.9%) in the late group (absolute risk reduction for early vs late, 0.7%; 95% CI, -5.4% to 6.7%). Two-year mortality was 51.0% (95% CI, 46.4%-55.6%) in the early and 53.7% (95% CI, 49.1%-58.3%) in the late group (P = .74). Median critical care unit length of stay in survivors was 13.0 days in the early and 13.1 days in the late group (P = .74). Tracheostomy-related complications were reported for 6.3% (95% CI, 4.6%-8.5%) of patients (5.5% in the early group, 7.8% in the late group). For patients breathing with the aid of mechanical ventilation treated in adult critical care units in the United Kingdom, tracheostomy within 4 days of critical care admission was not associated with an improvement in 30-day mortality or other important secondary outcomes. The ability of clinicians to predict which patients required extended ventilatory support was limited. isrctn.org Identifier: ISRCTN28588190.

0 comments Cited 209 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation.

John Griffiths, Vicki S Barber, Lesley Morgan … (2005)

To compare outcomes in critically ill patients undergoing artificial ventilation who received a tracheostomy early or late in their treatment. The Cochrane Central Register of Clinical Trials, Medline, Embase, CINAHL, the National Research Register, the NHS Trusts Clinical Trials Register, the Medical Research Council UK database, the NHS Research and Development Health Technology Assessment Programme, the British Heart Foundation database, citation review of relevant primary and review articles, and expert informants. Randomised and quasi-randomised controlled studies that compared early tracheostomy with either late tracheostomy or prolonged endotracheal intubation. From 15,950 articles screened, 12 were identified as "randomised or quasi-randomised" controlled trials, and five were included for data extraction. Five studies with 406 participants were analysed. Descriptive and outcome data were extracted. The main outcome measure was mortality in hospital. The incidence of hospital acquired pneumonia, length of stay in a critical care unit, and duration of artificial ventilation were also recorded. Random effects meta-analyses were performed. Early tracheostomy did not significantly alter mortality (relative risk 0.79, 95% confidence interval 0.45 to 1.39). The risk of pneumonia was also unaltered by the timing of tracheostomy (0.90, 0.66 to 1.21). Early tracheostomy significantly reduced duration of artificial ventilation (weighted mean difference -8.5 days, 95% confidence interval -15.3 to -1.7) and length of stay in intensive care (-15.3 days, -24.6 to -6.1). In critically ill adult patients who require prolonged mechanical ventilation, performing a tracheostomy at an earlier stage than is currently practised may shorten the duration of artificial ventilation and length of stay in intensive care.

0 comments Cited 143 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report.

P Ciaglia, R. Firsching, C Syniec (1985)

The development by the senior author (P.C.) of percutaneous tracheostomy from cricothyroidostomy and subcricoid fingertip tracheostomy is traced, and the technique and patient material of percutaneous subcricoid tracheostomy is presented. This new technique consists of inserting a tracheostomy tube by the use of a J guide wire inserted through a cannula into the tracheal lumen. Tapered dilators follow the guide wire and dilate the opening in the tracheal walls. A tracheostomy tube snugly fitted over a dilator is then passed into the trachea between the cricoid cartilage and the first tracheal ring. This procedure avoids the immediate and postoperative complications of "standard" tracheostomy. An experience of 134 tracheostomies of various types culminated in the development of the percutaneous technique. To date 26 such operations on 24 patients have been done with no significant complications due to the operation. The percutaneous technique should reduce the severity and incidence of intraoperative complications. Late complications, which have been no problem to date, are being evaluated with longer follow-up and with a greater patient population.

0 comments Cited 103 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Ayfer Kaya Gök

Zuhal Çavuş

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MD

Title: Medicine

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: 07 February 2025

Publication date (Electronic): 07 February 2025

Volume: 104

Issue: 6

Electronic Location Identifier: e41472

Affiliations

[a ] Department of Anesthesiology and Intensive Care, University of Health Sciences, Gaziosmanpaşa Training Research Hospital, Istanbul, Turkey.

Author notes

[* ]Correspondence: Ayşe Vahapoğlu, Department of Anesthesiology and Intensive Care, University of Health Sciences Turkey, Gaziosmanpaşa Training Research Hospital, Osmanbey Street, 621 Street, Gaziosmanpaşa, Istanbul 34255, Turkey (e-mail: aysevahapoglu@ 123456yahoo.com ).

Author information

Ayşe Vahapoğlu https://orcid.org/0000-0002-6105-4809

Article

Publisher ID: MD-D-24-00452 Accession ID: 00044

DOI: 10.1097/MD.0000000000041472

PMC ID: 11813018

PubMed ID: 39928801

SO-VID: f68a72a4-0d40-4295-a06b-06afe8e16352

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 January 2024

Date revision received : 28 December 2024

Date accepted : 17 January 2025

Custom metadata

OPEN-ACCESS TRUE

SDC T

Keywords: mortality,percutaneous dilation tracheostomy,tracheostomy timing

Data availability:

Keywords: mortality, percutaneous dilation tracheostomy, tracheostomy timing

Percutaneous tracheostomy procedures and patient results in a tertiary intensive care unit: A single-center experience

Read this article at