Early versus late tracheostomy for critically ill patients

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

doi:10.1002/14651858.cd007271

Cited by 14 publications

(14 citation statements)

References 36 publications

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“…To date there has been no large‐scale study comparing the outcomes of early versus late tracheostomy for airway management in tetanus and given its rarity in developed countries there is unlikely to be sufficient numbers to investigate this. Evidence from general intensive care units into optimal timing of tracheostomy placement also remains inconclusive . For the three patients in our series, the tracheostomy was placed before day 10.…”

Section: Discussionmentioning

confidence: 91%

Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease

Wen

Webb

Miles

et al. 2016

J Paediatrics Child Health

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Section: Discussionmentioning

confidence: 91%

Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease

Wen

Webb

Miles

et al. 2016

J Paediatrics Child Health

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“…Early tracheostomy has been linked with fewer morbidities and mortalities in several studies, but there is still little consensus on appropriate timing of tracheostomy . A recent Cochrane review comparing early and late tracheostomy could not determine any strong evidence to support early tracheostomy . We hypothesized that the accessibility of percutaneous tracheostomy without the need for operating room availability would promote early tracheostomy.…”

Section: Discussionmentioning

confidence: 98%

Percutaneous versus surgical tracheostomy: timing, outcomes, and charges

et al. 2018

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Objectives/Hypothesis The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy. Study Design Retrospective cohort study. Methods A retrospective analysis was performed for all patients who underwent tracheostomy in 2015 to 2016 in New York State. Patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes and stratified to the type of tracheostomy performed. The primary outcome of interest was mortality at index stay. Secondary outcomes of interest included length of stay and total hospitalization charges. Results Of the 8,682 patients, 2,488 (28.7%) underwent percutaneous and 6,194 (71.3%) underwent surgical tracheostomy. At hospitals where both procedures were performed, percutaneous tracheostomy patients were older, had more comorbidities, and had lower income (P < .05). Timing of the tracheostomy relative to admission did not affect the type of tracheostomy performed. While controlling for patient characteristics and complications during the visit, percutaneous tracheostomy was associated with increased mortality (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.03‐1.33, P = .0153) and increased hospital charges (OR: + 7.76%, 95% CI: 5.4‐10.11, P < .0001). Length of stay was not affected by procedure type. Conclusions Surgical tracheostomies are more commonly performed than percutaneous tracheostomies across New York State. Older, lower‐income, and sicker patients have a higher chance of receiving percutaneous tracheostomies. Percutaneous approaches were associated with statistically significant increased mortality and higher charges despite no difference in length of stay. Further studies are needed to determine if these differences in outcomes are clinically significant. Level of Evidence NA Laryngoscope, 128:2844–2851, 2018

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“…Although the timing of the tracheostomy is important to mortality in ICU patients who receive tracheostomy, there is still no consensus on this topic . While some studies have emphasized that early opening of a tracheostomy has reduced mortality, in a recent Cochrane review that compared early and late tracheostomies, there was no strong evidence that early tracheostomy reduced mortality . Especially for ST, factors, such as incompatibility with operating room conditions or intense workload of the surgical team, can increase the development of morbidity and mortality .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Boran

Bilal

et al. 2020

Geriatrics Gerontology Int

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Aim To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. Methods A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube‐related complications, early stage local complications and late‐stage complications. Results The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early‐ and seven late‐stage complications developed in group 1, and three early‐ and three late‐stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. Conclusion Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••–••.

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Early versus late tracheostomy for critically ill patients

Cited by 14 publications

References 36 publications

Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease

Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease

Percutaneous versus surgical tracheostomy: timing, outcomes, and charges

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

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