Tracheotomy versus prolonged intubation in medical intensive care unit patients
1Service de Reanimation Medicale CHU Ibn Rochd1 Rue des H6pitaux, Quartier des Hopitaux
DOI: 10.22514/SV41.042009.4 Vol.4,Issue 1,April 2009 pp.21-23
Published: 09 April 2009
Introduction. The contribution of tracheotomy in comparison to intubation in patients on the resuscitation ward is debated. The main purpose of our study is to assess if tracheotomy compared to prolonged intubation, reduces the whole duration of ventilation, the frequency of nosocomial pneumopathy, the mean duration of hospitalisation in the resuscitation ward and mortality.
Patients and method. It is a retrospective and comparative study between two groups of patients who presented neurologi-cal or respiratory pathology and required mechanical ventilation for more than three weeks. The study lasted 7 years and involved 60 patients divided into 2 groups : the Tracheotomy Group (TG, n=30), in which a tracheotomy was performed between the eighth day and the fifteenth day, after the first period of tracheal intubation; and the Intubation Group (IG, n=30), where the patients were intubated throughout the period of hospitalization until extubation or death. We monitored the whole duration of ventilation, the frequency of nosocomial pneumopathy, the incidence of each technique as well as the mean duration of hospitalization in the resuscitation ward and the mortality rate. The two groups were similar in age, sex and gravity score : SAPS II and APACHE II.
Results. The results showed a significant statistical decrease of the whole duration of mechanical ventilation for the TG: 27.03 ± 3.31 days versus 31.63 ± 6.05 days for the IG (P = 0.001). However, there is no significant difference between the two groups, whereas the frequency of nosocomial pneumopathy is about 53.3% in the group with tracheotomy versus 70% for the intubated group (P = 0.18). This shows, on the other hand, the late prevalence of nosocomial pneumopathy in the tracheotomy group patients.
We noticed one case of bleeding after tracheotomy. Sinusitis was also diagnosed but without a significant difference between the two groups, 6.7% (2 cases) in the TG and 10% (3 cases) for the IG (P = 0.31). The mean duration of hospitali-zation didn’t differ between the two groups; it was 30.96 ± 9.47 days for the TG versus 34.26 ± 9.74 days for the IG (P = 0.10). The study shows that there is no statistically significant difference in mortality between the two groups, 26.7% in the TG versus 46.7% for the IG (P = 0.10).
Conclusion. It seems that tracheotomy, in medical ICU patients, leads to a shorter duration of ventilation, delayed nosoco-mial pneumopathy without the modification of its frequency and the mean duration of hospitalization or death.
tracheotomy, prolonged intubation, pneumopathy, mechani-cal ventilation, mortality
BOUBAKER CHARRA,ABDELHAMID HACHIMI,ABDELLATIF BENSLAMA,SAID MOTAOUAKKIL. Tracheotomy versus prolonged intubation in medical intensive care unit patients. Signa Vitae. 2009. 4(1);21-23.
1. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guidelines. Eur J Cardio-Thoracic Surg 2007;32(3):412-21.
2. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutane-ous dilatational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004;32(8):1689–94.
3. Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma 2004;57(2):251-4.
4. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy: A prospective study of 150 critically ill adult patients. Am J Med 1981;70(1):65–76.
5. Racy E, Bobin S. Locoregional, laryngeal and tracheal complications of endotracheal prosthesis. In: News in resuscitation and emergency. Paris: SRLF Publishing; 2000. p. 405-12.
6. Heffner JE, Scott MK, Sahn SA. Tracheostomy in the intensive care unit. Part 2: complications. Chest 1986;90(3):430–5.
7. Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in surgical critical care setting. Surgery 1990;108(4):655–9.
8. Berlauk JF. Prolonged endotracheal intubation versus tracheostomy. Crit Care Med 1986;14(8):742-5.
9. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. Br Med J 2005;330(7502):1243–8.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.