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VOLUME 16 , ISSUE 2 ( April, 2012 ) > List of Articles


An audit of characteristics and outcomes in adult intensive care patients following tracheostomy

Yiu Ming Ho, A. Peter Wysocki, James Hogan, Hayden White

Keywords : Intensive care, mechanical ventilation, tracheostomy

Citation Information : Ho YM, Wysocki AP, Hogan J, White H. An audit of characteristics and outcomes in adult intensive care patients following tracheostomy. Indian J Crit Care Med 2012; 16 (2):100-105.

DOI: 10.4103/0972-5229.99124

License: CC BY-ND 3.0

Published Online: 01-03-2018

Copyright Statement:  Copyright © 2012; The Author(s).


Background: Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome. Materials and Methods: Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis of Diagnostic Related Group coding and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification procedural code. The primary endpoint was in-hospital mortality. Contingency tables were generated for clinical variables and a chi-squared test was used to determine significance. Results: One hundred and sixty-eight patients underwent tracheostomy between January 1999 and 30 June 2008. In-hospital mortality was 22.6%. The probability of death was found to be independent of timing of tracheostomy, technique used (percutaneous vs. surgical), number of failed extubations and obesity. On univariate analysis, the null hypothesis of independence was rejected for age on admission (P = 0.014), diagnosis of sepsis (P = 0.0008) or cardiac arrest (P = 0.0016), Acute Physiology and Chronic Health Evaluation II score (P = 0.0319) and the Australasian Outcomes Research Tool for Intensive Care calculated risk of death (P = 0.0432). Conclusion: Although a number of patient factors are associated with worse outcome, tracheostomy appears to be a relatively safe technique in the Intensive Care Unit population.

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  1. Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. JAMA 2002;287:345-55.
  2. Early tracheostomy in intensive care trauma patients improves resource utilization: A cohort study and literature review. Crit Care 2004;8:R347-52.
  3. Schwartz′s Manual of Surgery. Sydney: McGraw-Hill Professional; 2006.
  4. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med 1999;159:383-8.
  5. Timing of tracheostomy as a determinant of weaning success in critically ill patients: A retrospective study. Crit Care 2005;9:R46-52.
  6. Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg 2005;189:293-6.
  7. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 2005;33:2527-33.
  8. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004;32:1689-94.
  9. Tracheal stenosis and obliteration above the tracheostoma after percutaneous dilational tracheostomy. Crit Care Med 2003;31:1574-6.
  10. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg 2000;232:233-41.
  11. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med 1981;70:65-76.
  12. Percutaneous tracheostomy tube obstruction: Warning. Chest 2002;122:1377-81.
  13. The incidence of tracheoarterial fistula in patients with chronic tracheostomy tubes: A retrospective study of 544 patients in a long-term care facility. Chest 2005;128:3906-9.
  14. Assessment of ventilation during the performance of elective endoscopic-guided percutaneous tracheostomy: Clinical evaluation of a new method. Chest 2004;126:159-64.
  15. Tracheostomy in the intensive care unit: A nationwide survey. Anesth Analg 2008;107:1639-43.
  16. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: A systematic review and meta-analysis. Crit Care 2006;10:R55.
  17. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 2000;161:1450-8.
  18. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005;330:1243.
  19. Evidence-based guidelines for weaning and discontinuing ventilatory support: A collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120:375S-95S.
  20. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 1989;96:178-80.
  21. Percutaneous versus surgical tracheostomy: A randomized controlled study with long-term follow-up. Crit Care Med 2006;34:2145-52.
  22. Tracheostomy protocol compliance: Herding cats? Crit Care Med 2008;36:1959-60.
  23. Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med 2008;34:1779-87.
  24. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Crit Care Med 2007;35:802-7.
  25. Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med 1999;27:1714-20.
  26. One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: Time to change the gold standard. J Am Coll Surg 2011;212:163-70.
  27. The role of early tracheostomy in blunt, multiple organ trauma. Am Surg 1992;58:346-9.
  28. Percutaneous versus surgical tracheotomy: An updated meta-analysis. Laryngoscope 2007;117:1570-5.
  29. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med 2008;36:2547-57.
  30. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: A randomized trial. Ann Intern Med 2011;154:373-83.
  31. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 1990;108:655-9.
  32. Bench-to-bedside review: Early tracheostomy in critically ill trauma patients. Crit Care 2006;10:201.
  33. Early vs late tracheostomy in critical care. Br J Hosp Med (Lond) 2009;70:510-3.
  34. The outcome of extubation failure in a community hospital intensive care unit: A cohort study. Crit Care 2004;8:R322-7.
  35. Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study. Crit Care Med 2004;32:998-1003.
  36. Early mortality rate of morbidly obese patients after tracheotomy. Laryngoscope 2008;118:2125-8.
  37. A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients. Crit Care 2007;11:R3.
  38. Morbid obesity in the medical ICU. Chest 2001;120:1989-97.
  39. Effect of obesity on intensive care morbidity and mortality: A meta-analysis. Crit Care Med 2008;36:151-8.
  40. Percutaneous versus surgical bedside tracheostomy in the intensive care unit: A cohort study. Minerva Anestesiol 2008;74:529-35.
  41. A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Crit Care Med 2001;29:926-30.
  42. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000;118:1412-8.
  43. A note on a general definition of the coefficient of determination. Biometrika 1991;78:691-2.
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