Survey of tracheostomy in the intensive care unit

Introduction

Tracheostomy is a frequent procedure in the ICU. Two decades ago, the percutaneous technique became an option as a less invasive way of performing, and has since become the most frequently chosen technique.

Objective

To describe our ICU's experience with tracheostomy.

Patients and methods

Retrospective research was made of our ICU unit database, and the only patients chosen for this research were those who underwent tracheostomy in ICU I and II during 2005 and 2006. During this period, 49 patients realized tracheostomy. The assisting medical staff and the ICU routine staff worked together and decided about the indications for tracheostomy and the choice of technique. Data such as age, APACHE II score, reason for admission to the ICU, indication for the tracheotomy, type of tracheostomy, complications related to the procedure, as well as the patient's evolution, were analyzed, in retrospect, from the patients' charts. The complications were classified as minor or major, according to their severity.

Results

The average age of the 49 patients submitted to the procedure was 67.7 ± 18.7 years. The APACHE II score varied from 6 to 34, with a median equal to 22 ± 6.72. The most frequent hospitalization causes were: pneumonia (28.5%), acute respiratory failure (22.4%) and stroke (18.3%). Concerning the tracheostomy indications, the most frequent was anticipation of prolonged mechanical ventilation, which occurred in 43 patients (87.8%), followed by protection of the airways, with six patients (12.2%) included in this case. The percutaneous technique was used in 32 patients (65.3%), and none of them required conversion to the conventional surgical technique. Nine complications occurred, the main one being autolimited bleeding (four cases). There was no mortality related to the procedure.

Conclusion

Tracheostomy is a safe procedure that can be performed in the patient's bed, with a low complication rate. The most utilized technique was the percutaneous technique, representing a tendency of procedure choice in detriment to the conventional surgical technique.