Comparison of Complications in Stroke Subjects Undergoing Early Versus Standard Tracheostomy

Abstract

BACKGROUND: Although the benefits of early tracheostomy have been discussed in numerous studies, it is still unclear whether it is safe to perform early tracheostomy on unstable stroke patients. The purpose of this study is to assess the influences of the timing of tracheostomy on the incidence of complications following surgical tracheostomy in stroke patients. METHODS: We retrospectively performed chart reviews of 95 stroke subjects who underwent tracheostomy. In terms of timing, procedures performed within 7 d of intubation were categorized as early tracheostomy, and those performed after 7 d were categorized as standard tracheostomy. The incidence of complications following tracheostomy was compared between the two groups. The risk factors for complication were also investigated. RESULTS: Among the 95 subjects, 59 (62.1%) received early tracheostomy and 36 (37.9%) received standard tracheostomy. The overall incidence of tracheostomy complications was 24.2%, and there was no significant difference in incidence between the two groups. A comparison of risk factors between the groups with and without complications revealed no significant differences in age, sex, body mass index, Glasgow coma scale score, stroke type, or history of underlying disease. However, activated partial thromboplastin time was significantly higher in the group with complication. CONCLUSIONS: There was no significant difference in the incidence of complications in stroke subjects undergoing early versus standard tracheotomy.

Tracheostomy in patients with ischemic stroke

“…Seder et al found very low tracheostomy-related complications rates (9% with ST and 8% with PT) (8). Other studies found between 19 and 25% tracheostomy-related complications rates in stroke patients (15,16). In our study, tracheostomy-related complications rates were 24.6% (21.1% with PT, and 29.6% with ST).…”

“…For critically ill patients, the recommended standard method for tracheostomy is bedside PT, or ST when PT is anatomically not applicable (7). The advantages of PT include short procedure time at bedside, lesser tracheostomy complications such as stoma infection or bleeding, and less tissue damage due to minimal dissection (15). In our study, we found that ST was more preferred between 2009-2011, whereas PT increased during the later years.…”

“…Tracheostomy is superior to endotracheal intubation because it reduces dead space, airway resistance, respiratory workload and laryngeal damage caused by prolonged intubation (4,7). Despite its advantages, tracheostomy is an invasive intervention and can cause various complications (15). Seder et al found very low tracheostomy-related complications rates (9% with ST and 8% with PT) (8).…”

Early versus late tracheostomy in patients with acute brain injury: Importance of SET score

“…Various observational studies in neurocritical patients suggested that earlier tracheostomy is associated with improved clinical outcome and reduced hospital stay. [ 4 ] It is still unclear whether and when ventilated patients with ischemic or hemorrhagic stroke should obtain a tracheostomy, and to recognize the need to tracheostomize these patients is a daily dilemma. This prospective study aims to assess the benefits of early tracheostomy in neurocritical patients on ventilator in terms of ICU-LOS (ICU-LOS), number of days on ventilator (ventilator days), incidence of ventilator-associated pneumonia (VAP), and mortality rates.…”

Trachealkanülenmanagement in der neurologisch-neurochirurgischen Frührehabilitation

“…Auf den rehabilitativen Verlauf wirken sich vor allem Spätkomplikationen wie Stenosen und Tracheomalazien, die nicht selten erst nach Dekanülierung manifest werden, sowie die Bildung von die Atmung beeinträchtigenden Granulationen und Granulomen aus [20,22,27,45,66]. Arrosionsblutungen werden meist durch intratracheales Absaugen hervorgerufen und weisen häufig auf eine Fehllage der TK hin (abb.…”