Early Percutaneous Tracheotomy Research Articles

Early percutaneous tracheotomy in coronavirus disease 2019 (COVID-19) and infection in healthcare personnel: a cohort study

The aim of this study was to evaluate the association between exposure to early percutaneous tracheotomy and increased risk of SARS-CoV-2 infection for personnel involved in the procedure. No association was found, infection rate was similar between operators exposed and not exposed to the procedure, therefore percutaneous tracheotomy seems safe for the staff involved.

The impact of early percutaneous tracheotomy on reduction of the incidence of ventilator associated pneumonia and the course and outcome of ICU patients

The aim of the study. The primary objec-tive of this study was to determine the differences in the incidence of respiratory infections and septic episodes in patients who underwent early percutaneous trache-otomy (ET) and in patients who underwent translaryngeal intubation i.e late trache-otomy (LT). Secondary objectives were to determine the differences in the early mortality of patients, duration of mechani-cal ventilation and length of Intensive care unit (ICU) stay.Materials and methods. The study included 72 surgical and trauma patients older than 18 years of age, treated at the ICU of the University Clinical Hospital Mostar who had undergone translaryngeal intubation and were mechanically ventilated for at least 48 hours. The basic criterion for inclu-sion in the study was expected duration of mechanical ventilation of at least 14 days. Forty-eight hours after enrollment, patients were randomly divided into two groups. The first group of patients underwent ET after 2-4 days of mechanical ventilation; the second group underwent LT if they ex-hibited longer episodes of hypoxemia after 15 days. Results. The ET group of patients spent less time in mechanical ventilation and ICU. The ET group had a lower rate of VAS pneumonia (p=0.137), sepsis episodes (p=0.029) and mortality rate (p=0.056). Conclusion. The results of our study sup-port ET being performed 2–4 days from the start of mechanical ventilation. De-spite a lack of power, we found significant benefits of ET regarding the incidence of pneumonia, sepsis, hospital mortality, du-ration of mechanical ventilation and length of ICU stay

Comparación de traqueotomía percutánea precoz y tardía en unidad de cuidados intensivos para adultos

Background and objectivesPercutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. MethodsPercutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0-7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18years old, patients with positive end-expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL−1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. ResultsThere was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). ConclusionEarly tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Comparação de traqueotomia percutânea precoce e tardia em unidade de terapia intensiva para adultos

Background and objectivesPercutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. MethodsPercutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0–7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end‐expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL‐1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. ResultsThere was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). ConclusionEarly tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Comparison of early and late percutaneous tracheotomies in adult intensive care unit

Background and objectivesPercutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. MethodsPercutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0–7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL−1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. ResultsThere was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). ConclusionEarly tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Early Percutaneous Tracheotomy Versus Prolonged Intubation of Mechanically Ventilated Patients After Cardiac Surgery

Whether early percutaneous tracheotomy in patients who require prolonged mechanical ventilation can shorten mechanical ventilation duration and lower mortality remains controversial. To compare the outcomes of severely ill patients who require prolonged mechanical ventilation randomly assigned to early percutaneous tracheotomy or prolonged intubation. Prospective, randomized, controlled, single-center trial (ClinicalTrials.gov registration number: NCT00347321). Academic center. 216 adults requiring mechanical ventilation 4 or more days after cardiac surgery. Immediate early percutaneous tracheotomy or prolonged intubation with tracheotomy 15 days after randomization. The primary end point was the number of ventilator-free days during the first 60 days after randomization. Secondary outcomes included 28-, 60-, or 90-day mortality rates; durations of mechanical ventilation, intensive care unit stay, and hospitalization; sedative, analgesic, and neuroleptic use; ventilator-associated pneumonia rate; unscheduled extubations; comfort and ease of care; and long-term health-related quality of life (HRQoL) and psychosocial evaluations. There was no difference in ventilator-free days during the first 60 days after randomization between early percutaneous tracheotomy and prolonged intubation groups (mean, 30.4 days [SD, 22.4] vs. 28.3 days [SD, 23.7], respectively; absolute difference, 2.1 days [95% CI, -4.1 to 8.3 days]) nor in 28-, 60-, or 90-day mortality rates (16% vs. 21%, 26% vs. 28%, and 30% vs. 30%, respectively). The durations of mechanical ventilation and hospitalization, as well as frequencies of ventilator-associated pneumonia and other severe infections, were also similar. However, early percutaneous tracheotomy was associated with less intravenous sedation; less time of heavy sedation; less haloperidol use for agitation, delirium, or both; fewer unscheduled extubations; better comfort and ease of care; and earlier resumption of oral nutrition. After a median follow-up of 873 days, between-group survival, psychosocial evaluations, and HRQoL were similar. The prolonged intubation group had more ventilator-free days during days 1 to 60 than what was hypothesized (mean, 23.0 days [SD, 17.0]). Early tracheotomy provided no benefit in terms of mechanical ventilation and length of hospital stay, rates of mortality or infectious complications, and long-term HRQoL for patients who require prolonged mechanical ventilation after cardiac surgery. However, the well-tolerated procedure was associated with less sedation, better comfort, and earlier resumption of autonomy. French Ministry of Health.

Early percutaneous tracheotomy in cardiac surgery patients is a save procedure even in patients with coagulation disorders

Objectives: An early tracheotomy may shorten time of mechanical ventilation and length of stay at the ICU. In general, coagulopathy is a contraindication for surgical tracheotomy. However, some cardiac surgery patients may require an adequate anticoagulation due to mechanical valve replacement or any kind of assist device. In this study we reviewed our patients who underwent percutaneous tracheotomy (PDT) after cardiac surgery. The primary end point was the coagulopathy related bleeding complication.