Tracheotomy versus prolonged intubation in medical intensive care unit patients

Abstract

Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward is debated. The main purpose of our study is to assess if tracheotomy compared to prolonged intubation, reduces the whole duration of ventilation, the frequency of nosocomial pneumopathy, the mean duration of hospitalisation in the resuscitation ward and mortality.Patients and method. It is a retrospective and comparative study between two groups of patients who presented neurologi-cal or respiratory pathology and required mechanical ventilation for more than three weeks. The study lasted 7 years and involved 60 patients divided into 2 groups : the Tracheotomy Group (TG, n=30), in which a tracheotomy was performed between the eighth day and the fifteenth day, after the first period of tracheal intubation; and the Intubation Group (IG, n=30), where the patients were intubated throughout the period of hospitalization until extubation or death. We monitored the whole duration of ventilation, the frequency of nosocomial pneumopathy, the incidence of each technique as well as the mean duration of hospitalization in the resuscitation ward and the mortality rate. The two groups were similar in age, sex and gravity score : SAPS II and APACHE II. Results. The results showed a significant statistical decrease of the whole duration of mechanical ventilation for the TG: 27.03 ± 3.31 days versus 31.63 ± 6.05 days for the IG (P = 0.001). However, there is no significant difference between the two groups, whereas the frequency of nosocomial pneumopathy is about 53.3% in the group with tracheotomy versus 70% for the intubated group (P = 0.18). This shows, on the other hand, the late prevalence of nosocomial pneumopathy in the tracheotomy group patients.We noticed one case of bleeding after tracheotomy. Sinusitis was also diagnosed but without a significant difference between the two groups, 6.7% (2 cases) in the TG and 10% (3 cases) for the IG (P = 0.31). The mean duration of hospitali-zation didn’t differ between the two groups; it was 30.96 ± 9.47 days for the TG versus 34.26 ± 9.74 days for the IG (P = 0.10). The study shows that there is no statistically significant difference in mortality between the two groups, 26.7% in the TG versus 46.7% for the IG (P = 0.10).Conclusion. It seems that tracheotomy, in medical ICU patients, leads to a shorter duration of ventilation, delayed nosoco-mial pneumopathy without the modification of its frequency and the mean duration of hospitalization or death.