Early versus Late Tracheostomy: A Systematic Review and Meta‐analysis

Liu, C. Carrie; Livingstone, Devon; Dixon, Elijah; Dort, Joseph C.

doi:10.1177/0194599814541627a34

Cited by 34 publications

(66 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, the duration of ICU stay was found significantly shorter in patients diagnosed with COPD than in those not diagnosed. We believe that detailed Prolonged intubation and ICU stay increase not only hospital costs but also mortality and morbidity rates (12)(13)(14). In our study, a significant negative correlation was also found between FEV1 and duration of intubation in patients who underwent mitral valve surgery.…”

Section: Discussionsupporting

confidence: 54%

Preoperative airway obstruction as a cause of morbidity in patients undergoing mitral valve replacement

Erdinç¹,

Saraçoğlu²,

Dalar³

et al. 2018

Kocaeli Med J

View full text Add to dashboard Cite

-mail: anesthesiayten@gmail.com Başvuru Tarihi: 04.11.2017 Kabul Tarihi:22.01.2018 Kocaeli Med J 2018; 7; 1:70-76 ARAŞTIRMA MAKALESİ/ ORIGINAL ARTICLE 71 INTRODUCTIONToday, cost analyses for coronary artery bypass and valve surgery have gained more importance. Duration of intensive care unit (ICU) and hospital stay of patients is among the main factors determining the cost of treatment. Although patients undergo similar surgical procedures and are monitored in the same unit, the duration of ICU and hospital stay may vary. Concomitant diseases of patients should be carefully evaluated and treated, then the treatment costs of patients who undergo coronary bypass and valve surgery can be reduced (1). It is of primary importance to predefine risk factors that trigger such conditions such as prolonged intubation and ICU stay, which may affect the cost.Several studies have revealed that as a systemic disease, chronic obstructive pulmonary disease (COPD) is an important risk factor in patients undergoing valve and coronary surgery (2,3). Specified risk scoring methods also indicate that COPD is a risk factor in surgical procedures (4).It is essential that preoperative risk factors are assessed with additional tests and supported with additional treatments. There may be differences in clinical studies since duration of postoperative intubation and ICU stay in coronary bypass and valve surgery depends on multiple interrelated factors. The aim of the present study is to reveal the relationship between postoperative morbidity and preoperative airway obstruction determined by preoperative assessment in patients undergoing mitral valve replacement, and to present the importance of preoperative assessment. METHODSFollowing the Ethics Committee approval of our University, we included 62 consecutive patients who underwent mitral valve replacement. We recorded the presence of airway obstruction diagnosed in the preoperative period. All patients' sex, presence of systemic disease and smoking history were recorded. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio and mid-expiratory flow (MEF) 25-75% values were recorded in spirometric measurements (ZAN 100 Pulmonary Spirometer, Colorado, USA). Echocardiography values were performed using GE-VingMed Vivid S5 Echo Doppler Ultrasound. Ejection fraction (EF), systolic pulmonary artery pressure (sPAP), degree of mitral regurgitation (MR) and tricuspid regurgitation (TR) were recorded. Durations of preoperative cardiopulmonary bypass (CPB) and aortic crossclamp (XCL) were recorded. Duration of intubation and length of ICU stay were also recorded. Preoperative and postoperative aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), creatinine and blood gas values (pH, carbon dioxide (CO2), oxygen (O2), hematocrit and glucose) were recorded using the Cobas 6000 analyzer series.Patients who underwent only mitral valve replacement were considered as single-operation patients, while patients who underwent corona...

show abstract

Section: Discussionsupporting

confidence: 54%

Preoperative airway obstruction as a cause of morbidity in patients undergoing mitral valve replacement

Erdinç¹,

Saraçoğlu²,

Dalar³

et al. 2018

Kocaeli Med J

View full text Add to dashboard Cite

show abstract

“…Furthermore, outcomes measured at the time of hospital discharge may inadequately capture patient-centered outcomes as multiple significant events in the care of patients with tracheostomy occur post-discharge 7 . Furthermore, several trials and meta-analyses related to tracheostomy timing 14,17,19,50 were published after 2012 and could have affected tracheostomy timing practice-patterns after our study period; changes in practice patterns after 2012 require further study. Additionally, conditions suspected at the time of admission which could have affected decisions regarding tracheostomy timing but were ultimately not confirmed, such as suspected cervical spine injury, could not be captured by the NIS.…”

Section: Discussionmentioning

confidence: 99%

“…Further, we investigated the association between early tracheostomy rates and total tracheostomy utilization rates within hospitals, and explored patient outcomes associated with early tracheostomy. Some have theorized 17–19 that a heterogeneous case-mix of patients included in studies of tracheostomy timing 11,20–28 may obscure potential benefits of early tracheostomy; therefore, we evaluated utilization and outcomes separately among patients with the two most common indications for tracheostomy – trauma and pneumonia/sepsis.…”

Section: Introductionmentioning

confidence: 99%

Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study*

Mehta

Cooke

Wiener

et al. 2016

Critical Care Medicine

View full text Add to dashboard Cite

Objective Controversy exists regarding perceived benefits of early tracheostomy to facilitate weaning among mechanically-ventilated (MV) patients, potentially leading to significant practice-pattern variation with implications for outcomes and resource utilization. We sought to determine practice-pattern variation and outcomes associated with tracheostomy timing in the United States. Design In a retrospective cohort study, we identified mechanically-ventilated patients with the most common causes of respiratory failure leading to tracheostomy: pneumonia/sepsis and trauma. ‘Early tracheostomy’ was performed within the first week of MV. We determined between-hospital variation in early tracheostomy utilization and the association of early tracheostomy with patient outcomes using hierarchical regression. Setting 2012 National Inpatient Sample. Patients 6,075 pneumonia/sepsis patients and 12,030 trauma patients with tracheostomy. Interventions None Measurements and Main Results Trauma patients were twice as likely as pneumonia/sepsis patients to receive early tracheostomy (44.5% vs 21.7%, p<0.001). Admission to hospitals with higher early tracheostomy-to-total-tracheostomy ratios was associated with increased risk for tracheostomy among MV trauma patients (adjusted OR=1.04, 95% CI 1.01–1.07) but not pneumonia/sepsis (adjusted OR=1.00, 95% CI 0.98–1.02). We observed greater between-hospital variation in early tracheostomy rates among trauma patients (21.9% to 81.9%) compared to pneumonia/sepsis (14.9% to 38.3%) (p<0.0001). We found no evidence of improved hospital mortality. Pneumonia/sepsis patients with early tracheostomy had fewer feeding tube procedures and higher odds of discharge home. Conclusion Early tracheostomy is potentially overused among mechanically-ventilated trauma patients, with nearly half of tracheostomies performed within the first week of MV and large unexplained hospital variation, without clear benefits. Future studies are needed to characterize potentially differential benefits for early tracheostomy between disease subgroups and to investigate factors driving hospital variation in tracheostomy timing.

show abstract

“…A systematic review and meta‐analysis performed by Liu et al investigating the effects of early tracheostomy found a reduction in ICU LOS (−9.13 days, 95% CI: −17.55 to −0.70 days) . Among the included studies, early and late tracheostomy varied between 2 and 8 days, and 6 and 28 days, respectively.…”

Section: Literature Reviewmentioning

confidence: 99%