Tuberc Respir Dis.  2012 Jun;72(6):481-485.

Factors Determining the Timing of Tracheostomy in Medical ICU of a Tertiary Referral Hospital

• Park YS
• Lee J
• Lee SM
• Yim JJ
• Kim YW
• Han SK
• Yoo CG

Abstract

BACKGROUND
Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU).
METHODS
Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study.
RESULTS
Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and PaO2/FiO2<300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores> or =20 (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks.
CONCLUSION
APACHE II scores> or =20 and time delay for tracheostomy were associated with tracheostomy after 2 weeks.

Keyword

APACHE; Intensive Care Units; Time; Tracheostomy

MeSH Terms

APACHE
Cardiopulmonary Resuscitation
Humans
Intensive Care Units
Intubation, Intratracheal
Male
Multivariate Analysis
Organ Dysfunction Scores
Respiration, Artificial
Retrospective Studies
Tertiary Care Centers
Tracheostomy

Reference

1. Holevar M, Dunham JC, Brautigan R, Clancy TV, Como JJ, Ebert JB, et al. Practice management guidelines for timing of tracheostomy: the EAST Practice Management Guidelines Work Group. J Trauma. 2009. 67:870–874.

2. Epstein SK. Anatomy and physiology of tracheostomy. Respir Care. 2005. 50:476–482.

3. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004. 32:1689–1694.

4. Zagli G, Linden M, Spina R, Bonizzoli M, Cianchi G, Anichini V, et al. Early tracheostomy in intensive care unit: a retrospective study of 506 cases of video-guided Ciaglia Blue Rhino tracheostomies. J Trauma. 2010. 68:367–372.

5. Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010. 303:1483–1489.

6. Dunham CM, LaMonica C. Prolonged tracheal intubation in the trauma patient. J Trauma. 1984. 24:120–124.

7. Kluge S, Baumann HJ, Maier C, Klose H, Meyer A, Nierhaus A, et al. Tracheostomy in the intensive care unit: a nationwide survey. Anesth Analg. 2008. 107:1639–1643.

8. Blot F, Melot C. Commission d'Epidémiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005. 127:1347–1352.

9. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996. 22:707–710.

10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985. 13:818–829.

11. Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989. 96:178–180.

12. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med. 2005. 33:2513–2520.

13. Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008. 36:2547–2557.

14. Durbin CG Jr, Perkins MP, Moores LK. Should tracheostomy be performed as early as 72 hours in patients requiring prolonged mechanical ventilation? Respir Care. 2010. 55:76–87.

15. Freeman BD, Kennedy C, Robertson TE, Coopersmith CM, Schallom M, Sona C, et al. Tracheostomy protocol: experience with development and potential utility. Crit Care Med. 2008. 36:1742–1748.