EARLY VERSUS LATE TRACHEOTOMY IN THE INTENSIVE CARE UNIT

Ivica Dimitrov; Darko Sazdov; Nikola Shikov; Pande Chukalevski; Natalija Chakar Georgievska

Ivica Dimitrov General Intensive Care Unit, Clinical Hospital Acibadem Sistina, Skopje, North Macedonia
Darko Sazdov General Intensive Care Unit, Clinical Hospital Acibadem Sistina, Skopje, North Macedonia
Nikola Shikov General Intensive Care Unit, Clinical Hospital Acibadem Sistina, Skopje, North Macedonia
Pande Chukalevski General Intensive Care Unit, Clinical Hospital Acibadem Sistina, Skopje, North Macedonia
Natalija Chakar Georgievska General Intensive Care Unit, Clinical Hospital Acibadem Sistina, Skopje, North Macedonia

Abstract

Prolonged intubation and mechanical ventilation in critically ill patients can lead to several complications such as: Tracheomalacia, tracheoesophageal fistula, pulmonary atelectasis, respiratory infections, which is why tracheotomy is recommended. Also, the purpose of tracheotomy is shortening of the dead space in the airways and easier release (weaning) from mechanical ventilation. To determine the association of early and late tracheotomy with: Total days from tracheotomy to first ventilator weaning, total days of spontaneous breathing-T cannula, Non-invasive ventilation and mechanical ventilation before and after tracheotomy, number of bronchoaspirations, atelectasis and number of respiratory infections (with causative bacteria) before and after tracheotomy, length of hospitalization, death in intensive care and comorbidities. To determine the association of total days from tracheotomy to first ventilator weaning with gender and age of patients and to to determine the percentage of complications in early VS late tracheotomy. This comparative study includes 56 patients aged from 18 to 91 years with elective surgical tracheotomy. Patients are divided into 2 groups:

28 patients with early tracheotomy (time from intubation to tracheotomy â‰¤7 days)

28 patients with late tracheotomy (time from intubation to tracheotomy >7 days).

The length of hospitalization was significantly longer in the late tracheotomy group (p=0.0013). The number of days of mechanical ventilation before tracheotomy was significantly higher in patients with late tracheotomy (p=0.000001). The mortality rate was significantly higher in the late tracheotomy group (p=0.009). No statistical significance was found between the time from tracheotomy to the first weaning, the number of bronchoaspirations and atelectasis before and after tracheotomy in both groups of patients. In our study, we determined that patients with late tracheotomy statistically have higher mortality, longer hospitalization and more frequent respiratory infections before tracheotomy compared to patients with early tracheotomy.

Keywords: early tracheotomy, late tracheotomy

References

1. Shan L, Zhang R, Li LD. Effect of timing of tracheotomy on clinical outcomes: an update meta-analysis including 11 trials. Chin Med Sci J. 2013 Sep;28(3):159-66. doi: 10.1016/s1001-9294(13)60042-5. Erratum in: Chin Med Sci J. 2013 Dec;28(4):241. PMID: 24074618.
2. 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. BMJ. 2005 May 28;330(7502):1243. doi: 10.1136/bmj.38467.485671.E0. Epub 2005 May 18. PMID: 15901643; PMCID: PMC558092.
3. Huang H, Li Y, Ariani F, Chen X, Lin J. Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS One. 2014 Mar 25;9(3):e92981. doi: 10.1371/journal.pone.0092981. PMID: 24667875; PMCID: PMC3965497.
4. Wang F, Wu Y, Bo L, Lou J, Zhu J, Chen F, Li J, Deng X. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011 Dec;140(6):1456-1465. doi: 10.1378/chest.11-2024. Epub 2011 Sep 22. PMID: 21940770.
5. Zhao, J., Zheng, W., Xuan, Nx. et al. The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital. BMC Anesthesiol 24, 39 (2024). https://doi.org/10.1186/s12871-024-02411-1.
6. Fernanda Kazmierski Morakami, Ana Luiza Mezzaroba, Alexandre Sanches Larangeira, Lucienne Tibery Queiroz Cardoso, Carlos Augusto MarÃ§al Camillo, Cintia MagalhÃ£es Carvalho Grion, "Early Tracheostomy May Reduce the Length of Hospital Stay", Critical Care Research and Practice, vol. 2023, Article ID 8456673, 4 pages, 2023. https://doi.org/10.1155/2023/8456673.
7. Chopra P, Sodhi K, Shrivastava A, Tandon S, Joia RK. Impact of early versus late tracheostomy on patient outcomes in a tertiary care multispeciality ICU. J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):458-463. doi: 10.4103/joacp.JOACP_229_18. Epub 2021 Oct 12. PMID: 34759562; PMCID: PMC8562452.
8. Patel SA, Plowman EK, Halum S, Merati AL, Sardesai MG. Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients. Laryngoscope. 2015 Sep;125(9):2134-8. doi: 10.1002/lary.25322. Epub 2015 Jul 7. PMID: 26152892.
9. Tanaka, A., Uchiyama, A., Kitamura, T. et al. Association between early tracheostomy and patient outcomes in critically ill patients on mechanical ventilation: a multicenter cohort study. j intensive care 10, 19 (2022). https://doi.org/10.1186/s40560-022-00610-x.
10. Kashlan, K.N., Williams, A.M., Chang, S.S., Yaremchuk, K.L. and Mayerhoff, R. (2019), Analysis of patient factors associated with 30-day mortality after tracheostomy. The Laryngoscope, 129: 847-851. https://doi.org/10.1002/lary.27345.
11. Shah RK, Lander L, Berry JG, Nussenbaum B, Merati A, Roberson DW. Tracheotomy outcomes and complications: a national perspective. Laryngoscope. 2012 Jan;122(1):25-9. doi: 10.1002/lary.21907. PMID: 22183625; PMCID: PMC3640863.
12. Sinha V, Semien G, Fitzgerald BM. Surgical Airway Suctioning. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448077.
13. Mehta AK, Chamyal PC. TRACHEOSTOMY COMPLICATIONS AND THEIR MANAGEMENT. Med J Armed Forces India. 1999 Jul;55(3):197-200. doi: 10.1016/S0377-1237(17)30440-9. Epub 2017 Jun 26. PMID: 28775631; PMCID: PMC5531884.
14. Kim MJ, Park YH, Park YS, Song YH. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients. Ann Rehabil Med. 2015 Oct;39(5):763-71. doi: 10.5535/arm.2015.39.5.763. Epub 2015 Oct 26. PMID: 26605174; PMCID: PMC4654083.
15. Touman, A. A. and Stratakos, G. K. (2018) â€˜Long-Term Complications of Tracheal Intubationâ€™, in Erbay, R. H. (ed.) Tracheal Intubation. Rijeka: IntechOpen. doi: 10.5772/intechopen.74160.
16. Jelic S, Cunningham JA, Factor P. Clinical review: airway hygiene in the intensive care unit. Crit Care. 2008;12(2):209. doi: 10.1186/cc6830. Epub 2008 Mar 31. PMID: 18423061; PMCID: PMC2447567.
17. Li, M., Zhu, Q. and Wang, X. (2017) â€˜CT findings of pulmonary infection in patients with endotracheal intubation and mechanical ventilationâ€™, Radiology of Infectious Diseases, 4(1), pp. 1â€“6. doi: https://doi.org/10.1016/j.jrid.2016.09.001.