Early versus Late Tracheostomy Promotes Weaning in Intensive Care Unit Patients: a retrospective observational study: Early versus Late Tracheostomy

Chrisoula Marinaki; Theodoros  Kapadochos; Theodoros  Katsoulas; Ivan Rubbi; Athanasia  Liveri; Areti  Stavropoulou; Antonio Bonacaro; Dimitrios  Papageorgiou

doi:10.23750/abm.v93iS2.12998

Early versus Late Tracheostomy Promotes Weaning in Intensive Care Unit Patients: a retrospective observational study

Early versus Late Tracheostomy

Authors

Chrisoula Marinaki ICU NURSE
Theodoros Kapadochos Department of Nursing, University of West Attica
Theodoros Katsoulas Department of Nursing, National and Kapodistrian University of Athens,
Ivan Rubbi School of Nursing, University of Bologna
Athanasia Liveri Department of Statistics and Insurance Science, University of Piraeus
Areti Stavropoulou Department of Nursing, University of West Attica
Antonio Bonacaro School of Health and Sports Sciences, University of Suffolk, UK https://orcid.org/0000-0003-4475-5280
Dimitrios Papageorgiou Department of Nursing, University of West Attica, Greece

DOI: https://doi.org/10.23750/abm.v93iS2.12998

Keywords:

tracheostomy, Intensive Care Units, mechanical ventilator, ventilator weaning, respiratory support, Covid-19, critical care nursing

Abstract

Background and aim: The time interval between the patients’ intubation and the performance of a tracheostomy has been considered as critical for the disease prognosis and outcome. The aim of the present study was to compare and contrast the outcomes of early vs late tracheostomy with regard to ICU patients’ weaning from respiratory support.

Methods: This retrospective observational study, involved patients who were hospitalized in two general and one Covid-19 ICUs of two tertiary hospitals in Athens and were subjected to tracheostomy. Data were collected from the patients’ medical records in order to estimate the duration of patient weaning and the number of days from the patients’ intubation until the time of tracheostomy. In the present study the term earlytracheostomy denotes tracheostomy performed within 14 days from patient intubation and late tracheostomydefines the tracheostomy carried out after 14 days. For Covid-19 patients, guidelines suggested that tracheostomies should be performed 21 days following intubation, due to the high risk of virus transmission.

Results: One hundred and thirty-one patients who underwent tracheostomy participated in the study. Most tracheostomies were performed using the percutaneous technique. The group of patients tracheostomized within 14 days after their admission in ICU weaned faster from respiratory support compared to ones who were tracheostomized after 14 days.

Conclusions: The most common distinction between early and late tracheostomy is 14 days, with early tracheostomy being more beneficial in terms of patients’ outcomes, and specifically ICU patients’ weaning.

References

Quiñones-Ossa GA, Durango-Espinosa YA, Padilla-Zambrano H, Ruiz J, Moscote-Salazar LR, Galwankar S, et al. Current status of indications, timing, management, complications, and outcomes of tracheostomy in traumatic brain injury patients. J Neurosci Rural Pract. 2020;11(2):222-229. doi: 10.1055/s-0040-1709971.

Robba C, Galimberti S, Graziano F, Wiegers E, Lingsma HF, Iaquaniello C, et al. Tracheostomy practice and timing in traumatic brain-injured patients: a CENTER-TBI study. Intensive Care Medicine. 2020; 46(5):983-994. Epub 2020 Feb 5. doi: 10.1007/s00134-020-05935- 5.

Timbrell D, Jankowski S. Management of and indications for tracheostomy in care of the critically ill patient. Surgery. 2018; 36(4):187–195. doi: https://doi.org/10.1016/j.mpsur.2018.01.006.

van der Lely AJ, Veelo DP, Dongelmans DA, Korevaar JC, Vroom MB, Schultz MJ. Time to wean after tracheotomy differs among subgroups of critically ill patients: Retrospective Analysis in a Mixed Medical/Surgical Intensive Care Unit. Respir Care. 2006; 51(12):1408 –1415.

Mahmood K, Cheng GZ, Van Nostrand K, Shojaee S, Wayne MT, Abbott M, et al. Tracheostomy for COVID- 19 respiratory failure: multidisciplinary, multicentre data on timing, Technique and Outcomes. Annals of surgery. 2021; 274(2):234- 239. doi: 10.1097/SLA.0000000000004955.

Tang Y, Wu Y, Zhu F, Yang X, Huang C, Hou G, et al. Tracheostomy in 80 COVID-19 patients: A multicenter, retrospective, observational study. Frontiers in Medicine. 2020; 7:615845 doi: 10.3389/fmed.2020.615845.

Miles BA, Schiff B, Ganly I, Ow T, Cohen E, Gender E, et al. Tracheostomy during SARS-CoV-2 pandemic: Recommendations from the New York Head and Neck Society. Journal of the sciences and specialties of the head and neck. 2020; 42(6):1282- 1290. doi: 10.1002/hed.26166.

Chao TN, Braslow BM, Martin ND, Chalian AA, Atkins J, Haas AR, et al. Tracheotomy in ventilated patients with COVID-19. Annals of Surgery. 2020; 272(1):e30–e32. doi: 10.1097/SLA.0000000000003956.

David AP, Russell MD, El-Sayed IH, Russell MS. Tracheostomy guidelines developed at a large academic medical center during the COVID-19 pandemic. Head Neck. 2020; 42(6):1291–1296. doi: 10.1002/hed.26191.

Takhar A, Walker A, Tricklebank S, Wyncoll D, Hart N, Jacob T, et al. Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic. Eur Arch Otorhinolaryngol. 2020; 277(8):2173–2184. Epub 2020 Apr 21. doi: 10.1007/s00405-020-05993-x.

Klotz R, Probst P, Deininger M, Klaiber U, Grummich K, Diener MK, et al. Percutaneous versus surgical strategy for tracheostomy: a systematic review and meta-analysis of perioperative and postoperative complications. Langenbeck’s Archives of Surgery. 2018; 403(2):137–149. Epub 2017 Dec 27. doi: 10.1007/s00423-017-1648-8.

Long SM, Chern A, Feit NZ, Chung S, Ramaswamy AT, Li C, et al. Percutaneous and open tracheostomy in patients with COVID-19: comparison and outcomes of an institutional series in New York City. Ann Surg. 2021; 273(3): 403-409. doi: 10.1097/SLA.0000000000004428.

Freeman BD. Tracheostomy update: when and how. Critical Care Clinics, 2017; 33(2):311–322. doi: 10.1016/j.ccc.2016.12.007.

McGrath BA, Brenner MJ, Warrillow SJ, Pandian V, Arora A, Cameron TS, et al. Tracheostomy in the COVID- 19 era: global and multidisciplinary guidance. The Lancet Respiratory Medicine. 2020; 8(7):717-725. Epub 2020 May 15. doi: 10.1016/S2213-2600(20)30230-7.

McCredie VA, Alali AS, Scales DC, Adhikari NKJ, Rubenfeld GD, Cuthbertson BH, et al. Effect of early versus late tracheostomy or prolonged intubation in critically ill patients with acute brain injury: a systematic review and meta-analysis. Neurocrit Care. 2017; 26(1):14–25. doi: 10.1007/s12028-016-0297-z.