Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients*

Abstract

On the basis of these observations, we conclude that tracheotomized mechanically ventilated ICU patients required less intravenous sedative administration, spent less time heavily sedated, and achieved more autonomy earlier.

Benefits of early tracheotomy: underpowered or overestimated?

“…Sedation requirements were not different between the two study groups, which is in part in line with recent data from our group [5] but opposite to results from others [6]. Unfortunately, however, data on cumulative dose were not given.…”

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

“…However, no data exist that give adequate direction as to when it is routinely advisable to change from a translaryngeal intubation to a tracheostomy." 39 A recent comprehensive review of the Project IMPACT database (109 ICUs) documented that tracheostomy placement occurred at a median of 9 d (interquartile range [5][6][7][8][9][10][11][12][13][14] after ICU admission. In a secondary analysis comparing surgical ICU subjects (n ϭ 539) at Barnes-Jewish Hospital with subjects from 18 surgical ICUs in the Project IMPACT database, it was found that tracheostomy placement occurred more commonly in the Barnes-Jewish group (54.2% vs 13.9%, P Ͻ .001).…”

“…3 Placement of a tracheostomy has become a viable alternative to prolonged endotracheal intubation, with the benefits of improving patient comfort, reducing need for sedation, lowering airway resistance, and allowing for easier airway care. [4][5][6] Complications related to tracheostomies include pneumothorax, bleeding, subglottic stenosis, tracheoesophageal fistula, vocal cord dysfunction, stomal granulation, persistent tracheal fistula, and scarring. 7 The indications, technique, timing, and selection of critically ill patients for tracheostomy have been topics of considerable debate.…”

Relationship between Tracheostomy and Ventilator-associated Pneumonia in Intensive Care

“…Bu komplikasyonların riski translarengeal entübasyon süresi uzadıkça artmaktadır. Trakeostominin tüp bakımının daha kolay olması, sekresyon kontrolü, özellikli kanüller sayesinde hastanın iletişi-mine izin vermesi, oral beslenmeye olanak sağlaması, hemşire bakımının daha kolay ve daha güvenli olması gibi birçok potansiyel faydaları mevcuttur (7)(8)(9). Ayrıca translarengeal tüpe göre havayolu direncini azaltır, MV'den ayrılma sürecini hızlandırır, hastanede ve YBÜ'de kalış süresini kısaltır.…”