Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.08.002
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of early and late percutaneous tracheotomies in adult intensive care unit

Comparação de traqueotomia percutânea precoce e tardia em unidade de terapia intensiva para adultos

Mehmet Duran; Ruslan Abdullayev; Mevlüt Çömlekçi; Mustafa Süren; Mehmet Bülbül; Tayfun Aldemir

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Abstract

Background and objectives: Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. Methods: Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0–7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10 cmH2O and those with bleeding diathesis or platelet count under 50,000 dL−1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. Results: There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p < 0.05). Conclusion: Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Keywords

Percutaneous tracheotomy, Early tracheotomy, Late tracheotomy

Resumo

Justificativa e objetivos: A traqueotomia percutânea tornou-se uma boa alternativa para os pacientes com previsão de intubação prolongada em unidades de terapia intensiva. Os benefícios mais importantes da traqueotomia são alta precoce da unidade de terapia intensiva e menos tempo de permanência no hospital. As complicações da intubação intratraqueal prolongada são: lesão da laringe, paralisia das pregas vocais, estenose glótica e subglótica, infecção e lesão traqueal. O objetivo deste estudo foi avaliar as potenciais vantagens da traqueotomia percutânea precoce versus traqueotomia percutânea tardia em unidade de terapia intensiva. Métodos: Traqueotomias percutâneas foram realizadas em 158 pacientes em unidade de terapia intensiva para adultos e analisadas retrospectivamente. Os pacientes foram alocados em dois grupos para traqueotomia precoce e tardia, de acordo com o tempo de intubação intratraqueal antes da traqueotomia percutânea. As traqueotomias consideradas precoces foram realizadas nos dias 0-7 de intubação intratraqueal e as tardias realizadas após o sétimo dia de intubação intratraqueal. Os pacientes com infecção no local da traqueotomia, intubação difícil ou potencialmente difícil, idade inferior a 18 anos, pressão positiva ao final da expiração acima de 10 cmH2O e aqueles com diátese hemorrágica ou contagem de plaquetas em 50.000 dL−1 foram excluídos do estudo. Os tempos de ventilação mecânica e internação em UTI foram registrados. Resultados: Não houve diferença estatística entre os dados demográficos dos pacientes. Os tempos de ventilação mecânica e de internação em unidade de terapia intensiva do grupo traqueotomia precoce foram menores e a diferença foi estatisticamente significativa (p < 0,05). Conclusão: Traqueotomia precoce reduz o tempo de ventilação mecânica e de internação em unidade de terapia intensiva. Portanto, sugerimos a traqueotomia precoce em pacientes com suspeita de intubação prolongada.

Palavras-chave

Traqueotomia percutânea, Traqueotomia precoce, Traqueotomia tardia

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