Timing of Tracheostomy in Intensive Care Unit Patients

Introduction The ideal timing of tracheostomy in intensive care units (ICUs) for critically ill patients undergoing prolonged mechanical ventilation (MV) is still a controversial issue. Objectives To determine the proper timing of tracheostomy and its impact on various clinical outcomes of adult patients in ICUs undergoing prolonged MV. Methods The present study consisted of a sample of 67 ICU adult patients who were submitted to open surgical tracheostomy and divided into two groups: 30 patients in the early tracheostomy (ET) group (within 1–10 days post intubation), and 37 patients in the late tracheostomy (LT) group (within 11–21 days post intubation). The correlation between the timing of tracheostomy of each group and various associated ICU clinical parameters were analyzed. Results The sample consisted of 61.19% male and 38.81% female patients, with a mean age of 47.263 ± 7.581 years. The mean MV duration in days was 7.91 ± 4.937 standard deviation (SD) in the ET group, and 15.32 ± 7.472 SD in the LT group (p = 0.001), with a mean sedation time of 6.13 ± 4.647 SD in the ET group, and of 11.98 ± 6.596 SD in the LT group (p = 0.001). The duration of the weaning process duration had a mean of 2.75 ± 2.586 SD days in the ET group, and of 5.39 ± 5.817 SD days in the LT group (p = 0.025), with a weaning failure rate of 28.57% in the ET group and 71.42% in the LT group (p = 0.01). The Mean ICU stay was 26.18 ± 4.732 SD in the ET group, and 11.98 ± 6.596 SD in the LT group (p = 0.879), and the incidence of ventilator-associated pneumonia (VAP) of 23.33% in the ET group and of 27.02% in the LT group (p = 0.15). Conclusion Early tracheostomy had a notable benefit in shortening the duration of the MV, lessening the sedation time and minimizing the risks of weaning failure, but it had no significant impact on both the overall duration of ICU stay and VAP incidence.

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Attributable Cost and Length of Stay for Patients With Central Venous Catheter—Associated Bloodstream Infection in Mexico City Intensive Care Units A Prospective, Matched Analysis

Infection Control and Hospital Epidemiology ◽

10.1086/510812 ◽

2007 ◽

Vol 28 (1) ◽

pp. 31-35 ◽

Cited By ~ 73

Author(s):

Francisco Higuera ◽

Manuel Sigfrido Rangel-Frausto ◽

Victor Daniel Rosenthal ◽

Jose Martinez Soto ◽

Jorge Castañon ◽

...

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Mexico City ◽

Venous Catheter ◽

Central Venous ◽

Icu Stay ◽

The Mean ◽

Length Of Icu Stay

Background.No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico.Objective.To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City.Design.An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI.Setting.Adult ICUs in 3 hospitals in Mexico City.Patients and Methods.A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments.Results.For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was $598, the mean extra hospital cost was $11,591, and the attributable extra mortality was 20%.Conclusions.In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.

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Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

Colombia Medica ◽

10.25100/cm.v44i3.1285 ◽

2013 ◽

pp. 184-188 ◽

Cited By ~ 4

Author(s):

Alvaro Sanabria ◽

Ximena Gomez ◽

Valentin Vega ◽

Luis Carlos Dominguez ◽

Camilo Osorio

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Critically Ill ◽

Medical Condition ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Adult Patients ◽

Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

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Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43015 ◽

2019 ◽

Vol 5 (2) ◽

pp. 118-122

Author(s):

Uzzwal Kumar Mallick ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Enayet Hussain ◽

Mohammad Asaduzzaman ◽

Md Sirajul Islam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intravenous Immunoglobulin ◽

Statistical Significance ◽

Axonal Neuropathy ◽

Male Predominance ◽

Icu Stay ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

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Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy in intensive care unit: a prospective observational study

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v2i2.13530 ◽

2015 ◽

Vol 2 (2) ◽

pp. 52-55

Author(s):

Asfar Azimee ◽

Taiyenjam Kennedy Singh

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Guide Wire ◽

Percutaneous Dilatational Tracheostomy ◽

Prospective Clinical Study ◽

Fiberoptic Bronchoscope ◽

Tracheal Mucosa ◽

Dilatational Tracheostomy ◽

Weaning Failure ◽

The Mean

Background: The aim of the study was to evaluate the safety of fiberoptic bronchoscope guided percutaneous dilatational tracheostomy performed in the intensive care unit.Methods: This was a prospective clinical study done on 30 critically ill patients in Intensive care unit. A puncture was made with 16G cannula at the second or third tracheal interspace which was confirmed by the fiberoptic bronchoscope. This was followed by insertion of guide wire through the cannula followed by insertion of the guiding catheter over the guide wire. The tract was enlarged with white single stage dilator to allow placement of a standard tracheostomy tube. The procedure was continuously monitored with the fiberoptic bronchoscope. Complications were noted during procedure and till patient’s stay in Intensive care unit.Results: The study included 18 (60%) male and 12 (40%) female patients. The mean age was 64.5±8 years. Percutaneous dilatational tracheostomy was done early (<10 days) in 10 (33.3%) patients and late (>10 days) in 20 (66.7%) patients. Fentanyl was used for the procedure in all the patients and among them 8 (26.6%) patients required injection rocuronium. Average procedure duration, from incision to suture for 30 patients was 12.6± 2 minutes. Indication for tracheostomy was weaning failure in 22 (73.3%) patients and airway maintenance in 8 (26.6%) patients. The mean duration patient remained on mechanical ventilation was 12.6 days and mean length of stay in critical care unit before shifting to ward was 7.6 days after tracheostomy. Acute postprocedure complications were transient bleed in four patients (13.3%), two (6.7%) had stomal bleeding, one (3%) had tracheal mucosa laceration and another (3%) had subcutaneous emphysema. No cases of stomal infection, pneumothorax, tracheal laceration, paratracheal insertion, pneumothorax and pneumomediastinum. There was no procedure-related mortality. Conclusion: Fiberoptic bronchoscope guided percutaneous dilatational tracheostomy is safe and the method of choice for elective tracheostomy in the majority of intensive care patientsJournal of Society of Anesthesiologists of Nepal 2015; 2(2): 52-55

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Abstract 17306: The Most Expensive Patients in the Hospital

Circulation ◽

10.1161/circ.130.suppl_2.17306 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Karen E Joynt ◽

Maggie Makar ◽

Atul Gawande ◽

David Cutler ◽

Ziad Obermeyer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prolonged Mechanical Ventilation ◽

Medicare Beneficiaries ◽

Maximum Charge ◽

Medicare Data ◽

Clinical Innovation ◽

Medicare Patients ◽

The Mean ◽

Poor Outcomes

Introduction: In the Medicare population, 1% of the patients is responsible for 15% of spending. There are two patterns typical of highest-cost patients: those who cycle in and out of the hospital with preventable conditions, and those who have a single catastrophic event. While a great deal of focus has been placed on the former, much less is known about the latter. We do know that a large proportion of these most-expensive patients receive prolonged mechanical ventilation (PMV). Methods/Results: We used national Medicare data to explore diagnoses, procedures, and costs associated with these most-expensive patients. There were 91,054 hospitalizations for Medicare patients with a DRG containing PMV in 2010. The majority of PMV patients were admitted emergently (71.9%); an additional 16.7% were admitted urgently. Elective admissions represented 9.5%, and trauma accounted for 1.8%. Median length of stay was 16 days, and the median stay in the intensive care unit was 11 days. Procedures were performed in the majority of these patients, and clinical outcomes were exceedingly poor (table). The financial costs associated with this group of patients were high. The average total hospitalization charge was $227,917; the maximum charge was over $9 million. The mean Medicare payment for PMV patients in 2010 was $61,995, with a maximum of $1.3 million. This was largely through the set DRG price (mean $59,491), though outlier payments (mean $5,957, maximum $1.2 million) and patient-paid coinsurance (mean $835, maximum $88,644) played a significant role as well. Conclusions: A small group of Medicare beneficiaries undergoing PMV have extremely high costs and poor outcomes. This shared clinical pathway suggests that there is room for improvement, both in terms of identifying these patients early during hospitalization to prevent progression to PMV, as well as in terms of clinical innovation to improve care within the intensive care unit for those who are already ventilated.

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Behavior of the functional independence domains in patients submitted to the revascularization of the myocardium during intensive care unit stay

Revista Pesquisa em Fisioterapia ◽

10.17267/2238-2704rpf.v8i2.1876 ◽

2018 ◽

Vol 8 (2) ◽

pp. 175-182

Author(s):

André Luiz Cordeiro ◽

André Raimundo Guimarães ◽

Thiago Araújo Melo ◽

Jefferson Petto ◽

Mansueto Gomes-Neto ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Myocardial Revascularization ◽

Functional Independence ◽

Preoperative Period ◽

Icu Stay ◽

Stay Time ◽

The Mean ◽

Functional Independence Measurement

INTRODUCTION: Functional Independence Measurement (MIF) is used to evaluate the functional status of patients being divided into domains and should be applied in patients undergoing cardiac surgery due to their high potential for deleterious effects. OBJECTIVE: To analyze the behavior of MIF domains in patients submitted to myocardial revascularization. MATERIALS AND METHODS: This is a cohort study. At the time of hospital admission, the functionality was evaluated through the MIF and computed the six domains. After the surgery on the day of discharge from the Intensive Care Unit (ICU), the MIF was again applied for comparison with the preoperative period and correlation with the length of stay in the ICU. RESULTS: A total of 38 patients were analyzed: 21 (55.3%) men, mean age was 57.3 ± 13.3 years. The mean ICU stay was 2.9 ± 1.3 days, with a FIM of 125.7 ± 0.5 and a mean of 87.4 ± 16.8 (p <0.001). In relation to the domains, a reduction was observed in all of them, with the exception of Communication from 14 to 13.1 ± 2.1 (p = 0.24) and Cognition 20.9 ± 0.1 to 19.2 ± 4, 4 (p = 0.24). However, there was a strong correlation between ICU stay time with the communication domains (r -0.76 and p <0.01) and cognition (r -0.77 and p <0.01). CONCLUSION: It is concluded that the functionality is reduced due to cardiac surgery and that the time spent in the ICU is directly related to the worsening of communication and cognition.

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Impact of early tracheotomy for successful prognosis of patients

Emergency Medical Service ◽

10.36740/emems202004103 ◽

2020 ◽

Vol 7 (4) ◽

pp. 261-266

Author(s):

Mateusz Lech ◽

Paulina Bakier ◽

Sylwia Jabłońska ◽

Rafał Milewski ◽

Emilia Duchnowska ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Prolonged Mechanical Ventilation ◽

Intensive Therapy ◽

University Hospital ◽

Individual Treatment ◽

Clinical Issue ◽

Early Tracheostomy ◽

Risk Of Death

Introduction: Complications associated with intra-hospital infections are an important clinical issue determining the further condition of hospitalized patients. One of the most invasive and of high risk of complications in ICU conditions is the otolaryngological procedure of opening the anterior wall of the trachea, aimed at introducing the tube into the lumen of the respiratory tract, enabling subsequent ventilation. Epidemiological data indicate that in Poland the percentage of patients admitted to the ICU annually, due to respiratory failure, who require the implementation of mechanical ventilation reaches 74%, where 41% is qualified for prolonged ventilation and requires a tracheostomy. The aim: The epidemiological analysis of patients under the care of the Department of Anaesthesiology and Intensive Care of University Hospital in Bialystok. Particular attention was paid to patients who underwent tracheostomy. Material and methods: The study material was collected based on the analysis of the patient’s individual treatment process cards, the results of microbiological tests functioning in the Department of Anaesthesiology and Intensive Therapy of the University Hospital in Bialystok. 115 patients were qualified for the study, including 48 women and 67 men. Results: Retrospective studies were based on medical records of 115 patients treated in the Intensive Care Unit of the Department of Anaesthesiology and Intensive Care, University Hospital in Bialystok in 2017-2018. The analysis involved patients after tracheostomy tube implementation, 48 were women and 67 men. Among the analyzed cases, 53 deaths (46.1%) occurred, and 62 subjects were discharged from the ICU (53.9%). Conclusions: Early tracheostomy significantly improved patients’ prognosis and reduced the risk of death. Cardio-respiratory failure with respiratory arrest may often be associated with the need for prolonged mechanical ventilation applied in patients with the aforementioned disease. Therefore, prevention in the form of early tracheostomy is important.

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Association of early tracheostomy with the mortality and complications of adult patients in intensive care unit

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a673 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

MF Aguilar Arzapalo ◽

◽

VL Avendaño ◽

AM Escalante ◽

J Gongora Mukul ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adult Patients ◽

Early Tracheostomy

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Early Versus Late Tracheostomy in Outcome of Patients Admitted in Neurosurgical Intensive Care Unit

Eastern Green Neurosurgery ◽

10.3126/egn.v2i2.29239 ◽

2020 ◽

Vol 2 (2) ◽

pp. 21-25

Author(s):

Shiwani Rai ◽

Prasansa Sharma ◽

Sofiya Makajoo ◽

Balgopal Karmacharya ◽

Nikunja Yogi

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Tertiary Care ◽

Early Tracheostomy ◽

Icu Stay ◽

Ventilation Duration ◽

Mechanical Ventilation Duration ◽

Significant Difference ◽

Neurosurgical Intensive Care

Background: Tracheostomy is a commonly performed procedure in neurosurgical Intensive Care Units (ICU) performed to secure airway, aid in pulmonary toileting, and minimize ventilator-associated pneumonia (VAP) in cases requiring prolonged mechanical ventilation. Although early tracheostomy has been advocated rampantly in recent days, its benefit over late tracheostomy and the timing itself has been very controversial. In this study, we tried to study the effect of timing of tracheostomy in the outcome of patients in our ICU. Materials and methods: This is a retrospective study carried out over a period of one and a half years in a tertiary care center in western Nepal. Early tracheostomy was defined as those done within 4 days of endotracheal intubation and late were those done thereafter. Outcomes were studied in terms of length of ICU stay, hospital stay, mechanical ventilation, duration of tracheostomy in situ, VAP and mortality and complication over 90 days. Statistical analysis was done using SPSS 20.0. Results: There were 67 cases included in the study, out of which 27(40.3%) underwent early and 40 (59.7%) underwent late tracheostomy. The Mean duration of ICU stay, tracheostomy in situ duration, mechanical ventilation duration, and VAP were the parameters showing a significant difference between the two groups. There were 13 (19.4%) cases having complications in our series of which 6 (9%) of cases were from the early tracheostomy group and 7 (10.4%) of the cases were from the late tracheostomy group (p=0.63). Conclusion: Early tracheostomy is beneficial in a neurosurgical patient in terms of a decrease in ICU stay, duration of mechanical ventilation, duration of tracheostomy in situ, and VAP.

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Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness

PLoS ONE ◽

10.1371/journal.pone.0248883 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0248883

Author(s):

Hilmi Demirkiran ◽

Mehmet Kilic ◽

Yakup Tomak ◽

Tahir Dalkiran ◽

Sadik Yurttutan ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Critical Illness ◽

Prolonged Mechanical Ventilation ◽

Tertiary Care ◽

University Hospitals ◽

Icu Stay ◽

Chronic Critical Illness ◽

Length Of Icu Stay

Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children’s hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.

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