Conventional tracheostomy in critically ill patients: a safe procedure

Introduction

Tracheostomy is a very usual procedure in critically ill patients and is assumed to have a low rate of complications when executed by experienced hands. We did not have data about this issue in our setting, so we decided to perform a prospective trial in order to observe the main characteristics of tracheostomies made in critically ill patients in two of our centers: a general ICU and a trauma ICU.

Materials and methods

We performed a prospective and observational trial during the period between 28 May 2004 and 16 December 2004 in two ICUs of two tertiary hospitals.

Results

During this period, 601 patients were admitted: 291 patients in the trauma ICU and 310 patients in the general ICU. Sixty-six patients (10.98%) were submitted to tracheostomia in the two centers, 40 (60.6%) in the trauma ICU and 26 (39.4%) in the general ICU. Forty-four (66.7%) were male. Acute stroke (ischaemic or haemorragic) was the main cause of admission to the ICUs among the tracheostomized patients (28.8%), followed by brain trauma (21.2%). The major cause of admission in the general ICU was respiratory insufficiency (38.4%), and was brain injury (32.5%) in the trauma unit. The mean Glasgow, SOFA and APACHE II scores at the day of tracheostomy were 7.5 ± 3.19, 5.4 ± 2.01 and 19.2 ± 5.46, respectively. The main indication to tracheostomy (90.9%) was prolonged invasive ventilation (90.9%). The tracheostomies were exclusively performed by an experienced head and neck surgeon in the two centers. Tracheostomies were performed inside the ICU setting in the trauma ICU and in the operation room in the other. There were no differences in the rate of complications between the two centers. The rate of intraoperative and early complications was very low. There were three minor bleeding complications (4.5%). The mean time of invasive ventilation was 20.9 ± 10.5 days. The mean time in the ICU was 22.7 ± 10.39 days. The mortality rate was 31.8% and none of the deaths were related to the tracheostomies.

Conclusions

Despite the fact that it was a procedure performed in very critically ill patients, tracheostomy was associated with very few minor complications in this sample. We hypothesized that this low rate of complications is due in part to the very high expertise of the operators involved in the realization of conventional tracheostomies in the two centers.