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Influence of tracheostomy on duration of weaning from mechanical ventilation
Critical Carevolume 13, Article number: P17 (2009)
There are several advantages of tracheostomy if compared with orotracheal intubation, such as a more comfortable state for the patient, more effective aspiration of the sputum of respiratory ways, reduction of respiratory way resistance and availability of peroral nutrition. These advantages also include more safe maintenance of the passableness of respiratory ways, reducing the terms of carrying out respiratory support and the patient staying in the ICU, decreasing the pneumonia development risk. This study is designed to compare the duration of weaning in patients with tracheostomy versus patients suffering orotracheal intubation.
For this observational prospective cohort study, multiple trauma patients requiring more than 72 hours of mechanical ventilation were prospectively selected. A group of patients that underwent early tracheostomy before weaning attempts (ET) were compared with a group of patients that underwent weaning attempts while being orotracheally intubated. Tracheostomy was performed for these patients only in case there were several unsuccessful attempts of weaning (forced tracheostomy) lasting more than 7 days (FT). The general patient state was estimated by the APACHE II score, traumatic damages have been estimated by the injury severity score, and the degree of infringement of consciousness has been estimated by the GCS.
Seventy-one patients meeting the inclusion criteria were subject to our trial. The ET group included 41 patients that underwent tracheostomy lasting 2 to 5 days from the moment of mechanical ventilation being started. The FT group consisted of 30 patients and tracheostomy was performed for 60% of them. Both groups of patients were statistically comparable. The median duration of mechanical ventilation was shorter in the ET group of patients (256 vs. 314 hours, P = 0.047). The median duration of weaning was also shorter in the ET group of patients (61 vs. 103 hours, P = 0.008) if compared with the FT group. In total, 34.1% of patients of the ET group suffered pneumonia, while in the FT group the percentage was 50% (P = 0.032). The mortality rate was almost the same in both groups (P = 0.944).
Results of this study show that early tracheostomy, if performed for patient's suffering severe combined trauma, reduces the duration of weaning. Early tracheostomy results in a decrease of the frequency of complications such as ventilator-associated pneumonia. The duration of tracheostomy did not affect the mortality rate of the investigated groups of patients.