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Critical Care

Open Access

Tracheostomy in the ICU: an analysis of 443 procedures

  • A Marbán1 and
  • J López1
Critical Care200913(Suppl 1):P20

https://doi.org/10.1186/cc7184

Published: 13 March 2009

Keywords

Neuromuscular DiseaseCritical Care UnitTracheal StenosisMain DiagnosisChronic Respiratory Failure

Introduction

The aim of this study is to analyse our experience with tracheostomies performed in the critical care unit of a tertiary university hospital.

Methods

A retrospective clinical records review of patients who underwent this procedure in a 7-year period.

Results

From January 2001 to December 2007, 6,333 patients were admitted to our unit; 1,528 needed mechanical ventilation (MV) for more than 48 hours and 443 underwent tracheostomy. The median age was 56 years (14 to 88 years); 66% were male. The median APACHE II score was 20 (4 to 44). The main diagnoses were polytrauma including head injury in 24.2%, other structural neurological diseases in 21%, and prolonged weaning of various aetiologies in 35%. The percutaneous dilational technique was used in the majority of cases (90%). The mean duration of MV prior to tracheostomy was 13.8 days (SD = 6.4). The overall complication rate was 6%. Intraprocedural complications were atelectasis (0.4%) and bleeding (2%). Two of the patients needed surgical control or transfusion (0.4%). Two stoma infections developed in the open tracheostomy group. The most frequent complication was tracheal stenosis, encountered in 15 patients (3%). The ICU mortality was 20.7%. Of the 351 patients discharged from the ICU, 45.8% were decannulated prior to discharge from the ICU and 31% in the ward; 23% of them could not be decannulated at any moment. Ward mortality in the group of patients decannulated in the ICU was 5%, 10% in the patients decannulated in the ward and 37% in those who failed decannulation, for a total of 50 deaths before hospital discharge (11%). The main diagnoses of the patients who died on the ward were: residual encephalopathy in 62% (postanoxic, posttraumatic or other causes), severe chronic respiratory failure in 10%, spinal cord injury in 6%, and neuromuscular disease in 4%.

Conclusion

We had a low rate of early complications, similar to other series, with no procedure-related deaths [1]. Our main complication was airway stenosis. As in other studies, patients who needed a tracheostomy belonged to a group of patients with a high severity and mortality. Some of them do not recover a satisfactory neurological and functional status to be decannulated and present a high ward mortality.

Authors’ Affiliations

(1)
University Hospital La Paz, Madrid, Spain

References

  1. Díaz-Regañón G, Miñambres E, Ruiz A, González-Herrera S, Holanda-Peña M, López-Espadas F: Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients. Anaesthesia 2008, 63: 1198-1203. 10.1111/j.1365-2044.2008.05606.xPubMedView ArticleGoogle Scholar

Copyright

© Marbán and López; licensee BioMed Central Ltd. 2009

This article is published under license to BioMed Central Ltd.

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