Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study
| Autor: | Matthias Preuß, Andreas Hecker, Joachim Klasen, Birgit Hecker, Thorsten Schmelzer, Florian Brenck, Tillo Koch, Winfried Padberg, Markus A. Weigand |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Care Critical Illness medicine.medical_treatment Risk Assessment Statistics Nonparametric Sex Factors Tracheostomy Reference Values Intensive care Intubation Intratracheal medicine Humans Intubation Hospital Mortality Prospective Studies Prospective cohort study APACHE Aged Mechanical ventilation Chi-Square Distribution business.industry Incidence (epidemiology) Age Factors Length of Stay Middle Aged Respiration Artificial Surgery Cardiac surgery Intensive Care Units Treatment Outcome Emergency medicine Breathing Female business Ventilator Weaning Follow-Up Studies Abdominal surgery |
| Zdroj: | Langenbeck's Archives of Surgery. 397:1001-1008 |
| ISSN: | 1435-2451 1435-2443 |
| DOI: | 10.1007/s00423-011-0873-9 |
| Popis: | Long-term ventilation in intensive care units (ICUs) is associated with several problems such as increased mortality, increased rates of ventilator-associated pneumonia (VAP), and prolonged time of hospitalization, and thus leads to enormous healthcare expenditure. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient’s mortality is still controversial. The aim of our study was to investigate whether early tracheostomy improved outcome in critically ill patients. Within 2 years, 100 critically ill, predominantly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy was performed either early (≤4 days, 2.8 days median) or late (≥6 days, 8.1 days median) after intubation. We could demonstrate that mortality was not significantly reduced in the early tracheostomy (ET) group in contrast to the late tracheostomy (LT) group. ET was associated with decreased VAP incidence (ET 38% vs. LT 64%), decreased duration of ventilation (ET 367.5 h vs LT 507.5 h), and shorter time of hospitalization both in hospital (ET 31.5 days vs LT 68 days) and in ICU (ET 21.5 days vs LT 27 days). Despite many advantages like reduced time of ventilation and hospitalization, early tracheostomy is not associated with decreased mortality in critically ill patients. |
| Databáze: | OpenAIRE |
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