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Current Respiratory Medicine Reviews

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ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

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Research Article

The Impact of Tracheostomy Timing on the Duration and Complications of Mechanical Ventilation

Author(s): Renata de Souza Zaponi, Erica Fernanda Osaku, Lilian Regina Lengler Abentroth, Mayara Manzoni Marques da Silva, Jaiane Luiza Jaskowiak, Suely Mariko Ogasawara, Marcela Aparecida Leite*, Cláudia Rejane Lima de Macedo Costa, Itamar Regazzo Pedreschi Porto, Amaury Cezar Jorge and Pericles Almeida Delfino Duarte

Volume 15, Issue 4, 2019

Page: [272 - 280] Pages: 9

DOI: 10.2174/1573398X15666190830144056

Abstract

Background: Mechanical ventilation is a life support for ICU patients and is indicated in case of acute or chronic respiratory failure. 75% of patients admitted to ICU require this support and most of them stay on prolonged MV. Tracheostomy plays a fundamental role in airway management, facilitating ventilator weaning and reducing the duration of MV. Early tracheostomy is defined when the procedure is conducted up to 10 days after the beginning of MV and late tracheostomy when the procedure is performed after this period. Controversy still exists over the ideal timing and classification of early and late tracheostomy.

Objective: Evaluate the impact of timing of tracheostomy on ventilator weaning.

Methods: Single-center retrospective study. Patients were divided into three groups: very early tracheostomy (VETrach), intermediate (ITrach) and late (LTrach): >10 days.

Results: One hundred two patients were included: VETrach (n=21), ITrach (n=15), and LTrach (n=66). ITrach group had lower APACHE II (p=0.004) and SOFA (p≤0.001). Total ICU length of stay, and incidence of post-tracheostomy ventilator-associated pneumonia were significantly lower in the VETrach and ITrach groups. The GCS and RASS scores improved in all groups, while the maximal inspiratory pressure and rapid shallow breathing index showed a tendency towards improvement on discharge from the ICU.

Conclusion: Very early tracheostomy did not reduce the duration of MV or length of ICU stay after the procedure when compared to late tracheostomy, but was associated with low rates of ventilator-associated pneumonia. Neurological patients benefitted more from tracheostomy, particularly very early and intermediate tracheostomy.

Keywords: Intensive care unit, mechanical ventilation, prolonged mechanical ventilation, respiratory failure, tracheostomy, ventilator weaning.

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[1]
Schmidt GA, Girard TD, Kress JP, et al. Liberation From Mechanical Ventilation in Critically Ill Adults: Executive Summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline. Chest 2017; 151(1): 160-5.
[http://dx.doi.org/10.1016/j.chest.2016.10.037] [PMID: 27818329]
[2]
Rojek-Jarmuła A, Hombach R, Krzych ŁJ. APACHE II score cannot predict successful weaning from prolonged mechanical ventilation. Chron Respir Dis 2017; 14(3): 270-5.
[http://dx.doi.org/10.1177/1479972316687100] [PMID: 28774204]
[3]
Jarosz K, Kubisa B, Andrzejewska A, Mrówczyńska K, Hamerlak Z, Bartkowska-Śniatkowska A. Adverse outcomes after percutaneous dilatational tracheostomy versus surgical tracheostomy in intensive care patients: case series and literature review. Ther Clin Risk Manag 2017; 13(13): 975-81.
[http://dx.doi.org/10.2147/TCRM.S135553] [PMID: 28860781]
[4]
Kung SC, Lin WT, Tsai TC, et al. Epidemiologic characteristics and outcomes of major trauma patients requiring prolonged mechanical ventilation. Medicine (Baltimore) 2017; 96(52) e9487
[http://dx.doi.org/10.1097/MD.0000000000009487] [PMID: 29384944]
[5]
Loss SH, de Oliveira RP, Maccari JG, et al. The reality of patients requiring prolonged mechanical ventilation: a multicenter study. Rev Bras Ter Intensiva 2015; 27(1): 26-35.
[PMID: 25909310]
[6]
Cammann S, Timrott K, Vondran FWR, Schrem H, Lehner F, Klempnauer J, et al. Early tracheostomy reduces time of mechanical ventilation in respiratory high-risk patients after liver transplant. Exp Clin Transplant 2017.
[PMID: 29025380]
[7]
Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respir Care 2018.
[http://dx.doi.org/10.4187/respcare.04915]
[8]
Wang HK, Lu K, Liliang PC, et al. The impact of tracheostomy timing in patients with severe head injury: an observational cohort study. Injury 2012; 43(9): 1432-6.
[http://dx.doi.org/10.1016/j.injury.2011.03.059] [PMID: 21536285]
[9]
Mohamed KAE, Mousa AY, El Sawy AS, Saleem AM. Early versus late percutaneous tracheostomy in critically ill adult mechanically ventilated patients. Egypt J Chest Dis Tuberc 2014; 63(2): 443-8.
[http://dx.doi.org/10.1016/j.ejcdt.2014.01.008]
[10]
Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care 2014; 59(6): 895-915.
[http://dx.doi.org/10.4187/respcare.02971] [PMID: 24891198]
[11]
Mehta C, Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth 2017; 20(Suppl.): S19-25.
[http://dx.doi.org/10.4103/0971-9784.197793] [PMID: 28074819]
[12]
Khalili H, Paydar S, Safari R, Arasteh P, Niakan A, Abolhasani Foroughi A. An experience with traumatic brain injury: Is early tracheostomy associated with better prognosis? World Neurosurg 2017; 103: 88-93.
[http://dx.doi.org/10.1016/j.wneu.2017.02.060] [PMID: 28254541]
[13]
Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: A systematic review. Eur Arch Otorhinolaryngol 2018; 275(3): 697-90.
[PMID: 29255970]
[14]
Huang H, Li Y, Ariani F, Chen X, Lin J. Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS One 2014; 9(3)e92981
[http://dx.doi.org/10.1371/journal.pone.0092981] [PMID: 24667875]
[15]
Alabi BS, Afolabi OA, Dunmade AD, et al. Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review. Ann Afr Med 2018; 17(1): 1-6.
[http://dx.doi.org/10.4103/aam.aam_130_16] [PMID: 29363628]
[16]
MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001; 120(6)(Suppl.): 375S-95S.
[http://dx.doi.org/10.1378/chest.120.6_suppl.375S] [PMID: 11742959]
[17]
Durbin CG Jr, Perkins MP, Moores LK. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care 2010; 55(1): 76-87.
[PMID: 20040126]
[18]
Brook AD, Sherman G, Malen J, Kollef MH. Early versus late tracheostomy in patients who require prolonged mechanical ventilation. Am J Crit Care 2000; 9(5): 352-9.
[PMID: 10976359]
[19]
Andriolo BNG, Saconato HAÁN, Valente O. Early versus late tracheostomy for critically ill patients (Review) Cochrane Database of Systematic Reviews 2015.
[20]
Szakmany T, Russell P, Wilkes AR, Hall JE. Effect of early tracheostomy on resource utilization and clinical outcomes in critically ill patients: meta-analysis of randomized controlled trials. Br J Anaesth 2015; 114(3): 396-405.
[http://dx.doi.org/10.1093/bja/aeu440] [PMID: 25534400]
[21]
Meng L, Wang C, Li J, Zhang J. Early vs late tracheostomy in critically ill patients: a systematic review and meta-analysis. Clin Respir J 2016; 10(6): 684-92.
[http://dx.doi.org/10.1111/crj.12286] [PMID: 25763477]
[22]
Kang BH, Cho J, Lee JC, Jung K. Early versus late tracheostomy in trauma patients: a propensity-matched cohort study of 5 years’ data at a single institution in Korea. World J Surg 2018; 42(6): 1742-7.
[http://dx.doi.org/10.1007/s00268-018-4474-4] [PMID: 29344689]
[23]
Liu CC, Dort J. Re: Early versus late tracheostomy: A systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015; 152(4): 768-9.
[http://dx.doi.org/10.1177/0194599815572805] [PMID: 25833933]
[24]
Liu CC, Dort J. Re: Early versus late tracheostomy: A systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015; 152(4): 768-9.
[http://dx.doi.org/10.1177/0194599815572805] [PMID: 25833933]
[25]
Kaczmarek C, Aach M, Hoffmann MF, et al. Early percutaneous dilational tracheostomy does not lead to an increased risk of surgical site infection following anterior spinal surgery. J Trauma Acute Care Surg 2017; 82(2): 383-6.
[http://dx.doi.org/10.1097/TA.0000000000001320] [PMID: 27893643]
[26]
Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 1989; 96(1): 178-80.
[http://dx.doi.org/10.1378/chest.96.1.178] [PMID: 2500308]
[27]
Lesnik I, Rappaport W, Fulginiti J, Witzke D. The role of early tracheostomy in blunt, multiple organ trauma. Am Surg 1992; 58(6): 346-9.
[PMID: 1596033]
[28]
Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 2010; 303(15): 1483-9.
[http://dx.doi.org/10.1001/jama.2010.447] [PMID: 20407057]
[29]
Lu Q, Xie Y, Qi X, Li X, Yang S, Wang Y. Is early tracheostomy better for severe traumatic brain injury? A meta-analysis. World Neurosurg 2018; 112: e324-30.
[http://dx.doi.org/10.1016/j.wneu.2018.01.043] [PMID: 29337171]
[30]
Zheng Y, Sui F, Chen XK, et al. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chin Med J (Engl) 2012; 125(11): 1925-30.
[PMID: 22884055]
[31]
Trouillet JL, Luyt CE, Guiguet M, et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern Med 2011; 154(6): 373-83.
[http://dx.doi.org/10.7326/0003-4819-154-6-201103150-00002] [PMID: 21403073]
[32]
Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 2005; 33(11): 2527-33.
[http://dx.doi.org/10.1097/01.CCM.0000186898.58709.AA] [PMID: 16276177]
[33]
Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care 2005; 9(1): R46-52.
[http://dx.doi.org/10.1186/cc3018] [PMID: 15693966]
[34]
Raimondi N, Vial MR, Calleja J, et al. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva 2017; 41(2): 94-115.
[http://dx.doi.org/10.1016/j.medin.2016.12.001] [PMID: 28188061]
[35]
Lee YC, Wang HC, Hsu CL, Wu HD, Hsu HS, Kuo CD. The importance of tracheostomy to the weaning success in patients with conscious disturbance in the respiratory care center. J Chin Med Assoc 2016; 79(2): 72-6.
[http://dx.doi.org/10.1016/j.jcma.2015.10.004] [PMID: 26786864]
[36]
Nozawa E, Kobayashi E, Matsumoto ME, Feltrim MI, Carmona MJ, Auler JJ. Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery. Arq Bras Cardiol 2003; 80(3): 301-10.
[http://dx.doi.org/10.1590/S0066-782X2003000300006] [PMID: 12856273]

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