Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

Abstract

Background Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda. Methods In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7 days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software. Results All patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR = 1.8, 95%CI: 1.19 – 2.76), Bjork flap tracheal incision (RR = 1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR = 1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR = 1.22, 95%CI: 1.00 – 1.47). Conclusion Pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.

Impact of Vertical and Horizontal Skin Incisions on Outcome Measures in Tracheostomies

“…In immediate complications, the complication seen the most in the present study was tube dislodgement among four patients (V=1, H=3), similar to findings by Glossop et al [17], and Pal et al [18] This could be due to the procedure being done in bedridden, elderly patients who were unable to take care of the tracheostomy tube by themselves or due to the non-sutured neck tie to skin [19].…”

Indications of Tracheostomy in Patients Attending Baquba Teaching Hospital in Diyala, Iraq: A cross Sectional Study

“…Our finding is consistent with a previous study by Atmaca and colleagues (2011) at a specialized tertiary care center with 54 children, retrospectively. The generality indication for tracheotomy was prolonged intubation (87%), followed by upper airway obstruction (13%) [21]. Recently in Uganda, a prospective cohort study by Nyanzi et al (2023) of 100 patients undergone tracheostomy, they conclude that long-term ventilation was expected among the most common indications for tracheostomy in major hospitals [22].In our study there were 28% of the patients with trauma which included bullet injuries and chest injuries.…”

Trends for Percutaneous Tracheostomy in Italian Acute Care Setting over a 5-Year Period

“…Indications for tracheostomy in ICU included a wide range of options [ 7 ]. Tracheostomy is indicated in case of prolonged mechanical ventilation, difficult weaning, neurologic disease, incapability to protect the airways, and inability to manage secretions [ 11 ].…”