Prolonged intubation <i>vs.</i> tracheotomy: Complications, practical and psychological considerations

Astrachan, David I.; Kirchner, J. Cameron; Goodwin, W. Jarrard

doi:10.1288/00005537-198811000-00003

Cited by 136 publications

(12 citation statements)

References 10 publications

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“…Because long-term airway maintenance for up to a week may be warranted, an elective tracheostomy is recommended in high-risk patients after surgery, based on the patient's recovery status22. However, a tracheostomy is very invasive.…”

Section: Discussionmentioning

confidence: 99%

Elective tracheostomy scoring system for severe oral disease patients

Kim

2014

J Korean Assoc Oral Maxillofac Surg

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ObjectivesThe purpose of this research was to create a scoring system that provides comprehensive assessment of patients with oromaxillofacial cancer or odontogenic infection, and to statistically reevaluate the results in order to provide specific criteria for elective tracheostomy.Materials and MethodsAll patients that had oral cancer surgery (group A) or odontogenic infection surgery (group B) during a period of 10 years (2003 to 2013) were subgrouped according to whether or not the patient received a tracheostomy. After a random sampling (group A: total of 56, group B: total of 60), evaulation procedures were observed based on the group classifications. For group A, four factors were evaluated: TNM stage, reconstruction methods, presence of pathologic findings on chest posterior-anterior (PA), and the number of systemic diseases. Scores were given to each item based on the scoring system suggested in this research and the scores were added together. Similarly, the sum score of group B was counted using 5 categories, including infection site, C-reactive protein level on first visit, age, presence of pathologic findings on chest PA, and number of systemic diseases.ResultsThe scoring system rendered from this research shows that there is a high correlation between the scores and TNM stage in oral cancer patients, or infection sites in odontogenic infection patients. However, no correlation between pathologic findings on chest PA could be found in either group. The results also indicated that for both groups, the hospital day increased with the tracheostomy score. The tracheostomy score cutoff value was 5 in oral cancer patients and 6 in odontogenic infection patients which was used for elective tracheostomy indication.ConclusionThe elective tracheostomy score system suggested by this research is a method that considers both the surgical and general conditions of the patient, and can be very useful for managing patients with severe oral disease.

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Section: Discussionmentioning

confidence: 99%

Elective tracheostomy scoring system for severe oral disease patients

Kim

2014

J Korean Assoc Oral Maxillofac Surg

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“…16–26 Tracheostomy placement in mechanically ventilated patients is presumed to mitigate these discomforts by allowing for oral nutrition, 6 increased mobility, 14 and verbal communication. 27 However, patients continue to report physical and psychological distress after tracheostomy placement. In addition to pain, 28–29 fatigue, 28,30 frequent coughing, 28 and thirst, 31 patients describe anxiety related to feelings of powerlessness, 30 fear, 32 uncertainty about the future, 28–31 impaired communication, 28–29,31,33 and altered body image.…”

Section: Introductionmentioning

confidence: 99%

“…No identified quantitative studies specifically evaluated anxiety post-tracheostomy as a study aim Several researchers have assessed the broader category of patient comfort; 6,13,14 however, comfort includes but is not limited to anxiety. 32 Furthermore, measures and conclusions about patient comfort and anxiety rely almost exclusively on proxy indicators, such as decreased sedation needs 6,14,27 and nurse or family member assessments, 7,14,27 rather than first-person patient reports.…”

Section: Introductionmentioning

confidence: 99%

Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients

2014

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OBJECTIVE To determine if self-reported anxiety levels decreased after tracheostomy placement in a sample of mechanically ventilated intensive care unit patients. BACKGROUND There is limited research regarding the impact of a tracheostomy on patients’ anxiety. Elevated anxiety delays healing and contributes to long-term mental health complications. METHODS This was a secondary analysis of data from a large clinical trial conducted in urban Minnesota. Fifty-one of 116 patients received a tracheostomy. Anxiety scores were obtained daily using the Visual Analog Scale-Anxiety. Mixed model analysis was used to compare anxiety ratings pre- and post-tracheostomy. RESULTS There was no significant decrease in anxiety following tracheostomy after controlling for time and gender (all p>.16). Age was the only variable to impact anxiety levels: anxiety scores increased as age increased (p=.02). CONCLUSIONS Prospective studies are needed to more accurately assess the impact of tracheostomy placement on patient anxiety and salient outcomes.

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“…[14] As described in the literature, there were no deaths attributable to tracheostomy,[20] and the major cause of the mortality was the underlying severe head injury. Although tracheostomy is an increasingly used procedure, it may be associated with complications including stomal infection, stomal hemorrhage, major vascular injury, pneumothorax, subglotic stenosis, and tracheo-esophageal fistulae;[102033] therefore, a decision to perform the procedure should not be taken lightly. [27]…”

Section: Discussionmentioning

confidence: 99%

Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from a rural set-up of a developing country

Agrawal

Baisakhiya

Kakani

et al. 2011

Int J Crit Illn Inj Sci

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Background:Neurosurgical patients including patients with severe head injury are at risk of developing respiratory complications. These can adversely affect the outcome and can result in poor survival. Many studies confirm that tracheostomy is a safe, effective method of airway management for patients with severe head, facial and multisystem organ trauma.Aims:To know the indications for performing early tracheostomy and its outcome.Settings and Design:Retrospective data analysis.Materials and Methods:The present study is a retrospective analysis of all patients who were admitted with the diagnosis of head injury between January 2007 and December 2009 and underwent tracheostomy at a rural tertiary care trauma center of Central India.Results:During the study period, a total of 40 patients with head injury underwent tracheostomy. All the patients sustained head injury in road traffic accidents. The mean age of the patients was 37.6 years (range 14–75 years, standard deviation 14 ± 14.9 years). Maximum number of patients were in their third decade of life, followed by those in the fifth and fourth decades. There were 36 males and 4 females. Tracheostomy was performed in 30 patients with severe head injury, 9 patients with moderate head injury and in only one case of mild head injury as the patient had multiple facial injuries compromising the airway.Conclusions:Neurocritical care is a relatively new field in India, and the facilities for critical neurosurgical patients are available only in a very few tertiary care centers mainly serving the urban areas. In the present study, we discuss our limited experience with tracheostomy in patients with head injury while facing the challenge of limited resources.

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Prolonged intubation vs. tracheotomy: Complications, practical and psychological considerations

Cited by 136 publications

References 10 publications

Elective tracheostomy scoring system for severe oral disease patients

Elective tracheostomy scoring system for severe oral disease patients

Impact of tracheostomy placement on anxiety in mechanically ventilated adult ICU patients

Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from a rural set-up of a developing country

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