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Tracheostomy in the ICU: an analysis of 443 procedures
Critical Care volume 13, Article number: P20 (2009)
The aim of this study is to analyse our experience with tracheostomies performed in the critical care unit of a tertiary university hospital.
A retrospective clinical records review of patients who underwent this procedure in a 7-year period.
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%.
We had a low rate of early complications, similar to other series, with no procedure-related deaths . 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.
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.x
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Marbán, A., López, J. Tracheostomy in the ICU: an analysis of 443 procedures. Crit Care 13, P20 (2009). https://doi.org/10.1186/cc7184
- Neuromuscular Disease
- Critical Care Unit
- Tracheal Stenosis
- Main Diagnosis
- Chronic Respiratory Failure