Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study

Abstract

Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is the man indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.

Timing of Tracheostomy in Intensive Care Unit Patients

“…Another secondary outcome in the present study were post-intubation laryngotracheal injuries, such as laryngeal ulcer, laryngeal granuloma and subglottic stenosis, which were detected at a higher rate in the LT group than in the ET group, but with no statistically significant value. These findings were supported by other studies 35 36 37 that state that the concept of prolonged translaryngeal intubation is considered the most important factor in the incidence of these injuries. However, in the present study, all these pathologies were resolved with conservative management, without the need of surgical intervention.…”

Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center: a safe procedure with a wide spectrum of indications

“…The most common indication for tracheostomy was simultaneous major HNC surgery. This finding differs from some of the previous studies, where the most encountered indication was prolonged mechanical ventilation [ 10 – 12 ]. However, these studies are conducted at intensive care units, hence the study population differs from ours.…”

Prolonged Stay in Intensive Care Unit: Retrospective Analysis of Predisposing Factors and Outcome

“…Tracheotomy is the most frequent surgical procedure in ICUs with the indications of prolonged mechanical ventilation, weaning failure and obstruction in the upper airway. The LoS in patients with tracheotomy was reported longer than intubated patients (9,26). Our results also showed that the tracheotomy was a predictive factor of prolonged ICU stay.…”