post-ICU Patients Research Articles

A reply

Thank you for the opportunity to reply. We are very glad to see a growing enthusiasm for an objective discussion about the indications and outcome of percutaneous dilational tracheostomy. Our patient population included only post ICU patients that were rehabilitated but not yet decannulated. To our knowledge, such a study group has not been studied before. This is why many factors that may have contributed to the development of tracheal stenosis were not included in the study. We believe that this topic will benefit from prospective trials which include the follow-up of all patients and not just those who are symptomatic. Finally, we would agree with Bell and colleagues' sentiment: ‘the study provides a timely stimulus for all practitioners to think about their technique, patient selection, supervision of trainees, follow-up, collection of data under the principles of audit and governance, and provision of appropriate information when seeking consent or assent’.

Surgical technique affects the risk for tracheostoma-related complications in post-ICU patients

Conclusions. This study provides evidence that the surgical technique used for tracheotomy influences the risk of tracheostomy-related complications. Techniques resulting in an epithelialized tracheostoma seem to minimize the risk. Objective. Tracheotomies are frequently performed procedures in critically ill patients requiring long-term ventilation. Hence, we undertook a study to evaluate factors for tracheostomy-related complications among patients with a persisting stoma after critical care. Patients and methods. The patients underwent endoscopic examination of the tracheostoma, larynx, and trachea. The intensive care units (ICUs) were contacted with a questionnaire about the patient's diagnosis, the indication for the tracheotomy, the date of the tracheotomy, and the method of the tracheotomy procedure. Results. A total of 170 patients were included in this study. In all, 57.6% of the patients had unstable tracheostomas, a stenosis of the tracheal lumen above the stoma was encountered in 48.2% (G I, <50% of the lumen = 27.6% and G II, >50% of the lumen = 20.6%), and below the stoma in 3.5% of the patients. A significant association was found between severe suprastomal stenosis, tracheostoma instability and the use of dilatational tracheotomy (DT) (p<0.001). A malacia of the trachea was significantly more common among female patients (p < 0.010).