Early tracheotomy in elderly patients results in less ventilator‐associated pneumonia

Schneider, Glenn Todd; Christensen, Nathan; Doerr, Timothy D.

doi:10.1016/j.otohns.2008.11.006

Cited by 31 publications

(26 citation statements)

References 13 publications

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“…Tracheostomy reduces total mechanical ventilation time, shortens ICU and hospital stays, and is known to effectively reduce the occurrence of both pneumonia and hospital mortality. [1][2][3][4][5][6] A recent study examined the benefits of early tracheostomy, reporting that tracheostomy performed on stroke subjects within 1-3 d of intubation reduced ICU mortality, use of sedatives, and 6-month mortality. 7 In addition to these effects, another study reported that early tracheostomy in subjects who required postoperative mechanical ventilation following cardiac surgery effectively reduced hospital mortality, cardiac mortality, and the duration of ICU and hospital stays as compared with subjects who received late tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Complications in Stroke Subjects Undergoing Early Versus Standard Tracheostomy

et al. 2015

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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.

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Section: Introductionmentioning

confidence: 99%

Comparison of Complications in Stroke Subjects Undergoing Early Versus Standard Tracheostomy

et al. 2015

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“…The abovestated relative risk of VAP onset, seen in our "T" and "non-T" ICU patients, represents a crude risk ratio, since data on the potential confounders in mechanically ventilated patients who did not develop VAP during ICU stay were not collected at this point. According to the literature, the incidence of VAP among tracheotomized patients varies from 6% to 26% 9,31,32 . However, many studies failed to specify the time elapsed between tracheotomy and VAP onset.…”

Section: Discussionmentioning

confidence: 99%

“…The impact of tracheotomy on the development of VAP is not clearly defined. Some studies found decreases in VAP rates in patients having tracheotomy [6][7][8][9][10][11][12] , others have reported tracheotomy to be a risk factor favoring VAP onset [13][14][15][16][17][18][19][20] , while some could not demonstrate any VAP-related impact whatsoever [21][22][23][24] . Because of the conflicting literature data, there is currently no consensus on tracheotomy as either a VAP-protective or VAP-causative factor 5 .…”

Section: Introductionmentioning

confidence: 99%

The Impact of Tracheotomy on the Clinicalcourse of Ventilator-Associated Pneumonia

Turković

Lukić

Pažur

et al. 2016

ACC

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SUMMARY -Ventilator-associated pneumonia (VAP) is the most common infection among intensive care unit (ICU) patients. The aim of the present study was to evaluate the impact of tracheotomy on VAP clinical course. The study was conducted in a 15-bed Surgical and Neurosurgical ICU, Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital Center in Zagreb, Croatia. All patients developing VAP during ICU stay were eligible for the study. In VAP patients not tracheotomized during ICU stay, the mortality rate was approximately two times higher as compared with patients tracheotomized either before or after VAP onset (crude risk ratio 1.83, 95% confidence interval (95% CI) 1.15-2.91, p=0.01; crude odds ratio 3.47, 95% CI 1.52-7.94; p=0.003). In the surviving VAP patients, the duration of mechanical ventilation before VAP onset was higher in the "T before VAP" group as compared with the "no T before VAP" group (8, 6-10 vs. 3, 2-5; p<0.001), but the number of post-VAP days on mechanical ventilation was shorter in "T before VAP" patients than in "no T before VAP" patients (0, 0-1 vs. 4, 3-9; p<0.001). The duration of mechanical ventilation after VAP onset in the "T after VAP" group was longer as compared with the "T before VAP" group (4, 3-12 vs. 0, 0-1; p<0.001). The present study indicated tracheotomy to be associated with a reduced duration of mechanical ventilation after VAP onset, but only if patients were tracheotomized at the moment of VAP onset.

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“…Thus, the use of tracheotomy procedures is ultimately increasing (10,11). Ventilator-associated pneumonia (VAP) is a common problem in patients on long-term mechanical ventilation in the ICU.…”

Section: Percutaneous Dilatational Tracheostomy (Pdt) Is Indicated Whmentioning

confidence: 99%

“…The risk factors are age greater than 60 years, multiple intubations, and even the tracheotomy itself. VAP incidence decreases when tracheotomies are performed earlier (11). All the components of the respiratory system are affected by aging, although at different rates; however, age in itself is not a risk factor of respiratory failure (12).…”

Section: Percutaneous Dilatational Tracheostomy (Pdt) Is Indicated Whmentioning

confidence: 99%

Percutaneous Tracheostomy Application to Geriatric Patients in an Intensive Care unit by Anaesthesiologists: An Analysis of 47 Cases

Yilmaz¹,

Albayrak²

2016

Cyprus J Med Sci

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BACKGROUNDPercutaneous dilatational tracheostomy (PDT) is indicated when prolonged mechanical ventilation is required. Although tracheostomy has only been applied by surgical techniques in the recent past, it is currently applied using PDT techniques. PDT is performed in a short time; it is a simple technique with a low complication rate and a smaller skin incision, and it can be performed at the patient's bedside. Elderly individuals comprise an increasing proportion of the population and represent a progressively expanding number of patients admitted to the intensive care unit (ICU) who require prolonged mechanical ventilation; thus, the number of tracheotomy procedures is ultimately increasing. In this study, we aimed to present our PDT practices in the elderly in our ICU. MATERIAL and METHODSAfter obtaining ethics committee approval, we conducted a retrospective chart review of 47 geriatric patients in the ICU who underwent PDT by an anaesthesiologist. RESULTS Eighteen patients died (38%) during hospitalization in the general ICU (of causes unrelated to PDT). Sixteen patients were successfully weaned from mechanical ventilation following PDT. The mean time interval from PDT to weaning from mechanical ventilation was 9.56±6.35 days (range: 1-23 days). Fourteen patients were discharged from the general ICU with tracheostomy cannulae, and five patients were discharged with household ventilators. The mean time interval from PDT to discharge from ICU was 24.00±11.86 days (range 5-45 days). CONCLUSIONThe Griggs technique for PDT appears to be safe when performed by anesthesiologists or intensive care physicians. It can be performed easily at the patient's bedside; thus, the transport of critically ill patients, especially geriatric patients, to the operating room can be averted.

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Early tracheotomy in elderly patients results in less ventilator‐associated pneumonia

Abstract: Early tracheotomy in elderly patients is associated with less ventilator-associated pneumonia, more frequent intubations, less total admission time, and a trend toward lower mortality.

Cited by 31 publications

References 13 publications

Comparison of Complications in Stroke Subjects Undergoing Early Versus Standard Tracheostomy

Comparison of Complications in Stroke Subjects Undergoing Early Versus Standard Tracheostomy

The Impact of Tracheotomy on the Clinicalcourse of Ventilator-Associated Pneumonia

Percutaneous Tracheostomy Application to Geriatric Patients in an Intensive Care unit by Anaesthesiologists: An Analysis of 47 Cases

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