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Tracheotomy versus prolonged intubation in medical intensive care unit patients

  • BOUBAKER CHARRA1
  • ABDELHAMID HACHIMI1
  • ABDELLATIF BENSLAMA1
  • SAID MOTAOUAKKIL1

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

*Corresponding Author(s): SAID MOTAOUAKKIL E-mail: inoh@kbd.hr

Abstract

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.

Keywords

tracheotomy, prolonged intubation, pneumopathy, mechani-cal ventilation, mortality

Cite and Share

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.

References

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.

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