Comparison of the Outcomes of Early Versus Late Tracheostomy in the Treatment of Critically Ill Patients: A Retrospective Multicenter Measurement Study Done in Two Hospital Centers in Lebanon.
apache-ii score
critically ill patients
early tracheostomy
prolonged mechanical ventilation
trahceostomy
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
06 Nov 2020
06 Nov 2020
Historique:
entrez:
11
12
2020
pubmed:
12
12
2020
medline:
12
12
2020
Statut:
epublish
Résumé
Background Benefits of early tracheostomy (ET) versus late tracheostomy (LT) while treating critically ill patients have been a matter of big debate in the last few years. Several meta-analyses tried to prove the benefits of ET in decreasing the duration of mechanical ventilation (MV), the length of intensive care unit (ICU) stay, and the mortality rates. However, no clear guidelines are available yet. This study will focus on comparing the outcomes of early tracheostomy versus late one. Methods This is a retrospective study done in two medical and surgical ICUs at "Sacre-Coeur Hospital" and "Rafik Hariri University Hospital" at Beirut, where we reviewed various files of patients who underwent elective tracheostomy for prolonged MV from January 2015 to June 2016. ET and LT were assumed to be procedures performed respectively before and after 10 days of MV. These two groups were subdivided based on the Acute Physiology and Chronic Health Evaluation II (APACHE II) score calculated in the first 24 hours of ICU admission. Data about short- and long-term mortality, the duration of MV, and the length of ICU stay were collected and compared. Results From a total of 45 patients, only 25 patients met the inclusion and exclusion criteria of whom 12 (48%) underwent ET and 13 (52%) patients underwent LT. In patients with APACHE II <25 (6 ET and 6 LT), ET was associated with 50% long-term mortality, 9.6 days mean duration of MV and 23 days mean length of ICU stay compared to 57% (P-value=0.05), 78 days (P-value=0.04) and 79 days (P-value=0.012) of respective parameters in LT groups. In patients with APACHE II >25 (6 ET and 7 LT), ET was associated with 50% long-term mortality, 8.6 days mean duration of MV and 24 days mean length of ICU stay compared to 84%, 105 days, 84 days of respective parameter in LT groups. Conclusions Our results are suggestive of the superiority of ET because it was associated with a reduced duration of MV, a decrease in the length of ICU stay, and, most importantly, a lower long-term mortality rate.
Identifiants
pubmed: 33304694
doi: 10.7759/cureus.11361
pmc: PMC7720922
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e11361Informations de copyright
Copyright © 2020, Moussa et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Langenbecks Arch Surg. 2012 Aug;397(6):1001-8
pubmed: 22322214
Chest. 2015 Nov;148(5):1242-1250
pubmed: 26313324
Otolaryngol Head Neck Surg. 2013 Jan;148(1):6-20
pubmed: 22990518
AACN Adv Crit Care. 2018 Winter;29(4):426-431
pubmed: 30523013
Crit Care Med. 1985 Oct;13(10):818-29
pubmed: 3928249
Chest. 2000 Sep;118(3):767-74
pubmed: 10988201
J Crit Care. 2018 Apr;44:285-288
pubmed: 29223743
Am J Med. 2006 Oct;119(10):897.e13-9
pubmed: 17000224
Tuberc Respir Dis (Seoul). 2012 Jun;72(6):481-5
pubmed: 23101014
Crit Care Res Pract. 2014;2014:840638
pubmed: 25298891
Chest. 2001 Dec;120(6 Suppl):375S-95S
pubmed: 11742959
Anaesthesiol Intensive Ther. 2016;48(2):89-94
pubmed: 26977852
Clin Respir J. 2016 Nov;10(6):684-692
pubmed: 25763477
Can J Respir Ther. 2016 Winter;52(1):27-8
pubmed: 26909011
Cochrane Database Syst Rev. 2017 Dec 04;12:CD008380
pubmed: 29199768
PLoS One. 2014 Mar 25;9(3):e92981
pubmed: 24667875