Tracheostomy in patients with long-term mechanical ventilation: A survey

Marchese, Santino; Corrado, Antonio; Scala, Raffaele; Corrao, Salvatore; Ambrosino, Nicolino; On behalf of the Intensive Care Study Group, Italian Association of Hospital Pulmonologists (AIPO),

doi:10.1016/j.rmed.2010.01.003

« Previous Next »Respiratory Medicine
Volume 104, Issue 5 , Pages 749-753, May 2010

Tracheostomy in patients with long-term mechanical ventilation: A survey

Santino Marchese
- Respiratory Intensive Care Unit, Terapia Intensiva Respiratoria, Ospedale Civico, ARNAS, Via C. Lazzaro, 2 – 90129 Palermo, Italy
- Corresponding author. Tel.: +39 091 666 3506; fax: +39 091 666 3505.
Antonio Corrado
- Respiratory Intensive Care Unit, Azienda Ospedaliera-Universitaria Careggi, Firenze, Italy
Raffaele Scala
- Pulmonary Unit, Ospedale S. Donato, ASL 8 Arezzo, Italy
Salvatore Corrao
- Department of Medicine, University of Palermo, Italy
Nicolino Ambrosino
- Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa,Volterra, Italy
- Weaning and Pulmonary Rehabilitation Unit, Auxilium Vitae, Volterra, Italy
On behalf of the Intensive Care Study Group, Italian Association of Hospital Pulmonologists (AIPO)

Received 10 July 2009; accepted 5 January 2010. published online 01 February 2010.

Summary

Background

Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transferred to respiratory ICU (RICU). Indications/timing for closing tracheostomy are discussed.

Aim and Method

We report results of a one-year survey evaluating: 1) clinical characteristics, types of tracheostomy, complications in patients admitted to Italian RICU in 2006; 2) clinical criteria and systems for performing decannulation, and outcome of patients undergoing tracheostomy (number decannulated; number non-decannulated/non-ventilated; number non-decannulated/ventilated; dead/lost patients).

Results

22/32 RICUs replied. There were 846 admissions of 719 patients (Mean age 64,3 (±14.2) years, 489 (68%) males). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24.4%); exacerbation of Chronic Obstructive Pulmonary Disease 222 (34.4%); neuromuscular diseases 200 (27.8%); surgical patients 77 (10.7%); thoracic dysmorphism 28 (3.8%); obstructive sleep apnea syndrome 16 (2.2%). Percutaneous tracheostomies were 65.9%. Major complications after tracheostomy were 2%. 427 tracheostomies were evaluated for decannulation: 96 (22.5%) were closed; 175 patients (41%) were discharged with home mechanical ventilation; 114 patients (26.5%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10%) died or lost.

The clinical criteria chosen for decannulation were: stability of respiratory conditions, effective cough, underlying diseases and ability to swallow. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube; laryngo-tracheoscopy; use of tracheal button and down-sizing.

Conclusions

There were few major complications of tracheostomy. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation. There was no agreement on indications and systems for closing tracheostomy.

Keywords: Tracheostomy, Intensive care unit, Long-term mechanical ventilation, Respiratory failure