Abstract
Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d’Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d’Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/−) and 6 a low level of proof (Grade 2+/−). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.
Highlights
Tracheotomy is a procedure commonly used in intensive care, albeit with great disparities between medical teams in terms of frequency (5–54%) and modality [1, 2]
The advantages are a reduction in pharyngolaryngeal lesions, lower risk of sinusitis, reduced sedation requirements, easier buccopharyngeal hygiene, improved patient comfort with easier communication, facilitated care by nursing personnel, maintenance of swallowing, possible glottic closure, simpler reinsertion in cases of accidental decannulation, and easier weaning from mechanical ventilation [5]
Early use of tracheotomy was associated with decreased incidence of ventilator-acquired pneumonia, reduced duration of mechanical ventilation and of intensive care, and so of costs, and decreased hospital mortality [6, 7]
Summary
Tracheotomy is a procedure commonly used in intensive care, albeit with great disparities between medical teams in terms of frequency (5–54%) and modality (surgical or percutaneous) [1, 2]. Risks, which are rare but sometimes serious. The advantages are a reduction in pharyngolaryngeal lesions, lower risk of sinusitis, reduced sedation requirements, easier buccopharyngeal hygiene, improved patient comfort with easier communication, facilitated care by nursing personnel, maintenance of swallowing, possible glottic closure, simpler reinsertion in cases of accidental decannulation, and easier weaning from mechanical ventilation [5]. Early use of tracheotomy was associated with decreased incidence of ventilator-acquired pneumonia, reduced duration of mechanical ventilation and of intensive care, and so of costs, and decreased hospital mortality [6, 7]. Rare and Trouillet et al Ann. Intensive Care (2018) 8:37 life-threatening complications, such as lesions of the brachiocephalic artery trunk, have been reported
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
