Early versus late tracheostomy for critically ill patients

Silva, Brenda Nazaré Gomes; Andriolo, Régis B; Saconato, Humberto; Atallah, Álvaro Nagib; Valente, Orsine

doi:10.1002/14651858.cd007271.pub2

Cited by 64 publications

(41 citation statements)

References 56 publications

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“…This may reflect a shift in practice towards the belief that earlier tracheostomy improves outcomes for critically ill patients, which has been well-established in adults (Gomes Silva et al, 2012) and has begun to gain acceptance in other pediatric populations, including trauma (Holscher et al, 2014) and burns (Palmieri, Jackson & Greenhalgh, 2002). However, even beyond this broader overall increase in tracheostomy, we found that children with CHD accounted for an increasing proportion of all tracheostomy admissions.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Maxwell

McMillan

2014

PeerJ

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Background. While single-institution studies reported the indications and outcomes of tracheostomy in children with congenital heart disease (CHD), no national analyses have been performed. We sought to examine the indications, performance, outcomes, and resource utilization of tracheostomy in children with CHD using a nationally representative database.Methods. We identified all children undergoing tracheostomy in the Kids’ Inpatient Database 1997 through 2009, and we compared children with CHD to children without CHD. Within the CHD group, we compared children whose tracheostomy occurred in the same hospital admission as a cardiac operation to those whose tracheostomy occurred without a cardiac operation in the same admission.Results. Tracheostomy was performed in n = 2,495 children with CHD, which represents 9.6% of all tracheostomies performed in children (n = 25,928), and 3.5% of all admissions for children with CHD (n = 355,460). Over the study period, there was an increasing trend in the proportion of all tracheostomies that were done in children with CHD (p < 0.0001) and an increasing trend in the proportion of admissions for children with CHD that involved a tracheostomy (p < 0.0001). The population of children with CHD undergoing tracheostomy differed markedly in baseline characteristics, outcomes, and resource utilization. Similarly, the subgroup of children whose tracheostomy was performed in the same admission as a cardiac operation differed significantly from those whose tracheostomy was not.Conclusions. Tracheostomy is an increasingly common procedure in children with CHD despite being associated with significantly greater resource utilization and in-hospital mortality. The population of children with CHD who undergo tracheostomy differs markedly from that of children without CHD who undergo tracheostomy, and important differences are observed between children who undergo tracheostomy in the same admission as a cardiac surgical procedure and those who undergo tracheostomy in a nonsurgical admission, as well as between children with single-ventricle physiology and children with two-ventricle physiology.

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Section: Discussionmentioning

confidence: 99%

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Maxwell

McMillan

2014

PeerJ

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“…We recommend the readers to refer other published documents for detailed discussion on prevention of HAP/VAP. [264401–442] The strategies for prevention of VAP relevant to local conditions are listed in Table 18. The group re-emphasized staff education programs by hospital infection control committee and the concerned infection control nurse on a weekly basis (2A).…”

Section: Other Issuesmentioning

confidence: 99%

Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations

et al. 2012

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“…[24,46,47] The epicenter of study has been on the timing of the intervention. For example, evidence from the recent SETPOINT trial found that early tracheostomy in ventilated intensive care stroke patients is feasible and safe, in addition to decreasing sedation requirements and lowering ICU mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, some patients require tracheostomy in order to facilitate weaning from mechanical ventilation, long-term airway protection, or a combination of the two. [24] As of yet, no studies have specifically identified the rate of tracheostomy in a general sampling of patients with severe ischemic strokes. While the clinimetric properties of various outcomes scales are criticized, [25] the rate of tracheostomy is a well-documented patient-centered outcome.…”

Section: Introductionmentioning

confidence: 99%

Tracheostomy after Severe Ischemic Stroke: A Population-based Study

Walcott

Kamel

Castro

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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Goal Stroke can result in varying degrees of respiratory failure. Some patients require tracheostomy in order to facilitate weaning from mechanical ventilation, long-term airway protection, or a combination of the two. Little is known about the rate and predictors of this outcome in patients with severe stroke. We aim to determine the rate of tracheostomy after severe ischemic stroke. Materials & Methods Using the Nationwide Inpatient Sample database from 2007–2009, patients hospitalized with ischemic stroke were identified based on validated International Classification of Diseases, 9th Revision, Clinical Modification codes. Next, patients with stroke were stratified based on whether they were treated with or without decompressive craniectomy, and the rate of tracheostomy for each group was determined. A logistic regression analysis was used to identify predictors of tracheostomy after decompressive craniectomy. Survey weights were used to obtain nationally representative estimates. Findings In 1,550,000 patients discharged with ischemic stroke nationwide, the rate of tracheostomy was 1.3% (95% CI, 1.2–1.4%), with a 1.3% (95% CI, 1.1–1.4%) rate in patients without decompressive craniectomy and a 33% (95% CI, 26–39%) rate in the surgical-treatment group. Logistic regression analysis identified pneumonia as being significantly associated with tracheostomy after decompressive craniectomy (OR 3.95; 95% CI 1.95–6.91). Conclusion Tracheostomy is common following decompressive craniectomy and is strongly associated with the development of pneumonia. Given its impact on patient function and potentially modifiable associated factors, tracheostomy may warrant further study as an important patient-centered outcome among patients with stroke.

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Early versus late tracheostomy for critically ill patients

Cited by 64 publications

References 56 publications

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations

Tracheostomy after Severe Ischemic Stroke: A Population-based Study

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