Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

Lim, Chor-Kuan; Ruan, Sheng‐Yuan; Lin, Feng-Ching; Wu, Cho‐Kai; Chang, Hou‐Tai; Jerng, Jih-Shuin; Wu, Huey-Dong; Yu, Chong‐Jen

doi:10.1371/journal.pone.0138294

Cited by 42 publications

(23 citation statements)

References 18 publications

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“…A similar reduction in overall mortality was reported in another 10-year review of 616 trauma patients that compared those who underwent percutaneous tracheostomy with those who underwent open tracheostomy (10 vs. 15%) [17].…”

Section: Complicationsupporting

confidence: 68%

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Airway Management in ICU Settings

Shallik¹,

Almustafa²,

Zaghw³

et al. 2017

Intensive Care

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Maintenance of patent airway, adequate ventilation, and pulmonary gas exchange is very important in critically ill patients. Airway management in intensive care patients differs significantly from routine surgical procedures in the operating room. The airway competence in intensive care unit (ICU) should be coping with the rapidly evolving advances in airway management. Therefore, efforts should be focused on the three pillars of airway master: airway providers as intensivists or critical care physicians, equipment, and operational plans. Not all institutions can afford all airway equipment in the market; however, they should make sure that critical care providers have a full access to the available tools and they are comfortable using it. Educational sessions and refresher courses should be tailored to meet the competence level of the ICU providers and equipment availability. Operational plan includes developing institutional airway protocols and implementing difficult airway guidelines. The protocols should consider different staffing models of ICU and make sure all the time at least one member of the team with the highest experience in airway should be always available. The aim of writing this chapter is to enable the intensivist to optimize their use of airway equipment and managing highrisk patients in ICU.Keywords: tracheal intubation, videolaryngoscopy (VL), flexible fiberoptic intubation, bronchoscopy, percutaneous tracheostomy, extubation in ICU, high-flow nasal cannula (HFNC), virtual endoscopy (VE), airway ultrasound, supra-glottic airway devices, tube exchange © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tracheal intubation in ICU IntroductionTracheal intubation (TI) is one of daily practiced procedures in the intensive care unit (ICU), especially when the patient has respiratory failure or cardiovascular collapse. It involves highly skilled techniques that require much of training, practice, and expertise. The excellence in airway management in ICU is necessary for intensivist's every day practice, which when it is lacking does not only compromise the quality of care but also has a potential impact on patient safety.The optimal intubation condition prevailing in surgical theaters differs a lot in nature than harsh and chaotic scenarios in ICU. The nature of those situations has three factors: the highly skilled anesthesiologists versus the intensivists; the compensated, well-controlled surgical patient versus the decompensated sick ICU patients; and equipment availability. That is why in ICU settings, the airway instrumentation-related complications have higher incidence than anesthesia settings. Among the contributory factors for high failure rates are the highly stressful environment, limited expertise level of the providers with different te...

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Section: Complicationsupporting

confidence: 68%

“…The relative advantages and disadvantages of tracheostomy and endotracheal intubation are outlined in Table 3 [16][17][18][19][20].…”

Section: Tracheostomy Versus Intubationmentioning

confidence: 99%

Airway Management in ICU Settings

Shallik¹,

Almustafa²,

Zaghw³

et al. 2017

Intensive Care

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“…[39][40][41] In a prospective observational study of 86 intubated patients with difficulty weaning from mechanical ventilation who underwent tracheostomy, weaning parameters were shown to improve significantly upon conversion from ETT to tracheostomy. 42 An even greater increment in weaning parameter improvements after tracheostomy was seen in the subset of patients who were successfully weaned than those who were unsuccessfully weaned from mechanical ventilator.…”

Section: Indications and Benefitsmentioning

confidence: 98%

Percutaneous Tracheostomy

Al-Shathri

Susanto

2018

Semin Respir Crit Care Med

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Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication.

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“…Most of the available literatures discussing items related to tracheostomy in ICUs reported causes of admission to ICUs other than trauma. 10,11,13,14,16,17 However, the data available about trauma patients with head injury in ICUs were few or sporadic among other causes of admission in ICUs. [18][19][20] Comparisons with other studies In this study males were more than females with percentages 82.9% and 17.1% respectively, with male to female ration 4.8:1.…”

Section: Strengths Of the Studymentioning

confidence: 99%

Factors affecting decannulation of elective tracheostomy done for patients in intensive care units

Roushdy¹,

Abdel-gaffar²,

Saleh³

et al. 2018

Egyptian Journal of Neck Surgery and Otorhinolaryngology

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‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ــــــــــــــــــــــــــــ‬ Introduction: Prolonged intubation is the main indication for tracheostomy in intensive care units (ICUs). The aim of this study is to detect the factors affecting decannulation of tracheostomy done for patients in ICUs. Patients and Methods: It is a prospective cohort study. It was conducted in trauma ICUs of a tertiary care center. It included all patients who were admitted to ICUs during the period of the study and were subjected to prolonged intubation, mechanical ventilation and tracheostomy during their admission in ICUs, regardless of their age and sex. Decannulation was considered when no longer need for tracheostomy and after fulfilling criteria of decannulation. Decannulation was one staged and was considered successful if there was no need for reapplication of tracheostomy during six months of follow up. The participants were divided into two groups; successful decannulation group (DG) and failure of decannulation group (FDG). Factors affecting decannulation were detected by comparing the two groups; (DG) and (FDG). Results: DG included 52 patients and FDG included 29 patients. Tracheal stenosis and low conscious level were the cause of failure of decannulation in 44.8% and 41.4% of patients respectively. Statistically significant shorter duration of intubation and duration of mechanical ventilation were found in DG with p. value 0.015 and 0.025 respectively. The mean cannulation time of DG group was 49 days. Conclusion: Duration of intubation, duration of mechanical ventilation, development of tracheal stenosis, low conscious level and bad chest condition are the factors ruling decannulation of tracheostomy.Introduction:

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Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study

Cited by 42 publications

References 18 publications

Airway Management in ICU Settings

Airway Management in ICU Settings

Percutaneous Tracheostomy

Factors affecting decannulation of elective tracheostomy done for patients in intensive care units

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