Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos

Gandía-Martínez, F.; Martínez-Gil, Iñigo; Andaluz‐Ojeda, David; Lamo, F. Bobillo de; Parra-Morais, Laura; Díez-Gutiérrez, F.

doi:10.4321/s1130-14732010000300002

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…In our study, we found a reduction in the days of AMV in patients with early tracheostomy and making a new subgroup in patients who underwent tracheostomy before the day 4 of stay a radical reduction in the rate of pneumonia (63.6% ultra-early tracheostomy vs. 100% late tracheostomy). These results are similar as those reported by other authors 7,4,11,15 . Other authors differ in their results arguing that they found a decrease in the frequency of pneumonia 5,6,16,17 .…”

Section: Pneumonia Days Of Amv and Total Length Of Stay In Hospitalizationsupporting

confidence: 93%

“…These results show the direct relationship between the number of days with AMV and frequency of pneumonia and also this with the total length of stay. Some other authors have found that the use of early tracheostomy decreases the number of days with AMV 5,7,11,12 .…”

Section: Pneumonia Days Of Amv and Total Length Of Stay In Hospitalizationmentioning

confidence: 96%

“…Some authors have shown advantages by performing an early tracheostomy such as to reduce the rate of pneumonia 4 , days of AMV 5,6 , length of stay, and mortality 5,7,8 . It has been considered that patients that will require tracheostomy will profit by performing it earlier [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

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Traqueostomía en pacientes adultos con trauma craneoencefálico grave: factores asociados. Escala propuesta

Franco-Jiménez¹,

Ceja-Espinosa²,

Álvarez-Vázquez³

et al. 2020

CIRU

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Background:In patients with severe traumatic brain injury (TBI), there is a lack of consensus about the need and time to perform a tracheostomy. Nowadays, the decision is individualized to each case. It is considered that patients that will need a tracheostomy profit by performing it earlier. Patients and methods: An observational and prospective study was performed. One hundred and twenty patients in a period of 18 months between 2016 and 2018, older than 18 years, with severe TBI at the first 24 h of trauma were analyzed. Clinical, biochemical, and radiological findings at admission were measured; patients were followed up until discharge. The statistical analysis was made with Student's t-test, χ 2 , and prevalence risk ratio. Results: Ten associated factors were grouped according to the prevalence risk ratio. The principal factors were CRASH score, IMPACT score, SAPS II score, APACHE II score, age, revised trauma score, Glasgow Coma Scale, subdural hematoma, uni or bilateral abnormal pupil reactivity, and collapse of basal cisterns. Conclusions: We conclude that there are multiple factors associated with the need for tracheostomy in adult patients with severe TBI and it is possible to predict according to our findings from admission which patients will profit by this procedure.

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Section: Pneumonia Days Of Amv and Total Length Of Stay In Hospitalizationsupporting

confidence: 93%

Section: Pneumonia Days Of Amv and Total Length Of Stay In Hospitalizationmentioning

confidence: 96%

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Traqueostomía en pacientes adultos con trauma craneoencefálico grave: factores asociados. Escala propuesta

Franco-Jiménez¹,

Ceja-Espinosa²,

Álvarez-Vázquez³

et al. 2020

CIRU

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“…Gandía-Martínez, et al [23] have analyzed the early TQT (≤ 9 days) versus late TQT (> 9 days) in neurocritical patients. They have found that those neurocritics admitted to the ICU requiring TQT (subarachnoid hemorrhage and ischemic stroke) in the first 9 days of OTI shortened the MVA time and the consequent need for sedation, decreases the frequency of pneumonia by shortening the antimicrobial treatments, and decreases the stay in the ICU without modifying the duration of the hospital stay or the mortality in ICU or hospital.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Clinical Data and Identification of Variables Associated with the Success of Decannulation in Neurocritic Traqueostomized Patients

Escalier¹,

Papazian²,

Grimaldi³

et al. 2018

Int J Respir Pulm Med

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Introduction: Tracheostomy is a common procedure in long-term ventilated patients and frequent in those with severe stroke. Decannulation not only involves removal of the tracheostomy cannula, but also evaluation of upper airway protection. The predictors of success provide an objective guide to minimize the time of permanence of the same. Currently there are no studies on predictors of decannulation success in neurocritical patients. Objective: To analyze clinical and demographic data in a cohort of tracheostomized neurocritical adults in the Intensive Care Unit over a period of 9 months. Secondarily, to compare decannulated and non-decannulated patients to identify variables associated with decannulation success. Materials and method: We have analyzed the data of adult neurocritical tracheostomized patients during a stay in the Intensive Care Unit. Inclusion criteria: ≥ 18 years, neurocritical tracheostomized patients. Variables analyzed: Epidemiological data and personal antecedents, clinical follow-up variables: tracheostomy indication, tracheostomy timing, success of weaning, days of mechanical ventilation, success of decannulation, stay in Intensive Care Unit and ward, condition to discharge. Results: Prospective cohort study. Many of 32 patients were analyzed. Most frequent reason for admission was subarachnoid hemorrhage. The suspicion of prolonged weaning was the main criteria to perform a tracheostomy. Decannulation rate was 25%. When comparing decannulated/non-decannulated patients, statistically significant differences were found in age (p = 0.037), tracheostomy timing (p = 0.001), tracheostomy motive: suspicion of prolonged weaning (p = 0.004) and prolonged mechanical ventilation (p = 0.009); Successful weaning (100% vs. 54% respectively p = 0.029) and discharge condition. Conclusion: When analyzing clinical and demographic data, a greater percentage of females and subarachnoid hemorrhage was observed as a reason for more frequent admission. Both the suspicion of prolonged weaning and the prolonged mechanical ventilation were predominant causes of tracheostomy. The 66% of the tracheostomies were successfully removed; Decannulation rate was of 25%. When comparing decannulated and non-decannulated patients, significant differences were found in age, timing and reasons for tracheostomy, success in weaning, and condition at discharge. In those patients with successful decannulation, younger age, greater timing of tracheostomy and prolonged mechanical ventilation were observed as a reason for predominant tracheostomy.

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“…Tracheostomy is a common procedure in patients with TBI, with the purpose of facilitating respiratory management 13 . It is often associated with a lower prevalence of pneumonia, but some studies show the opposite 1,14-16 .…”

Section: Introductionmentioning

confidence: 99%

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

et al. 2018

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Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

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Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos

Cited by 7 publications

References 26 publications

Traqueostomía en pacientes adultos con trauma craneoencefálico grave: factores asociados. Escala propuesta

Traqueostomía en pacientes adultos con trauma craneoencefálico grave: factores asociados. Escala propuesta

Analysis of Clinical Data and Identification of Variables Associated with the Success of Decannulation in Neurocritic Traqueostomized Patients

Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

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