Ferguson, M. The findings also serve as a reminder that in the complex arena of randomized controlled trials in the ICU, correctly defining the target population is equally important as ensuring other key markers of methodological quality. This trial should convince clinicians that routine early tracheotomy most likely will not lead to reduced VAP, shorter hospital stay, or lower mortality. Most importantly, it shows that performing tracheotomy for perceived weaning failure must be tempered by the knowledge that many patients will improve with additional time.
Sometimes physicians just need to wait. Note: Content may be edited for style and length. Science News. Journal References : P. Terragni, M. Antonelli, R. Fumagalli, C. Faggiano, M. Berardino, F. Pallavicini, A. Miletto, S. Intubation is done when one cannot maintain their airway on their own due to anesthesia or illness. Often, a person is intubated for a short time, and a person would not go home when they are intubated.
Patients cannot be discharged with intubation and must have medical supervision. See Full List of Services. Expert Health Articles. Chang-Wen Chen, Email: wt. Jung-Der Wang, Email: moc. Liang-Miin Tsai, Email: wt. National Center for Biotechnology Information , U. BMC Anesthesiol. Published online Dec Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Sep 17; Accepted Dec 2.
This article has been cited by other articles in PMC. Abstract Background Tracheostomy is recommended for patients receiving mechanical ventilation MV for 14 days or more in the intensive care unit ICU. Methods A retrospective study was conducted using the admissions database of a bed ICU from January 1, , to December 31, Results Of the patients requiring prolonged MV, were tracheostomized after a median 18 days of MV. Conclusions Tracheostomy is associated with lower in-hospital mortality and higher successful weaning rates in ICU patients receiving prolonged MV.
Electronic supplementary material The online version of this article doi Study design This was a retrospective cohort study using anonymized data from an ICU clinical information system IntelliVue Clinical Information Portfolio, Philips derived from a single center. Patients and setting Data were obtained from patients admitted to the bed adult ICU at the tertiary referral center of southern Taiwan between January 1, , and December 31, Statistical analysis We categorized the patients into a tracheostomy group and a translaryngeal tube group.
Table 1 Demographic and clinical characteristics of patients mechanically ventilated for at least 14 days. Open in a separate window. Table 2 Clinical outcomes of patients receiving mechanical ventilation for at least 14 days. Table 3 Factors associated with in-hospital mortality and successful weaning in patients receiving mechanical ventilation for at least 14 days.
Table 4 Case-matched study: demographic and clinical characteristics of patients mechanically ventilated for at least 14 days. Conclusions Tracheostomy was independently associated with reduced ICU and in-hospital mortality, and increased successful weaning rate, for critically ill patients requiring MV for at least 14 days. Key messages For patients requiring MV for at least 14 days, tracheostomy was significantly associated with reduced ICU and hospital mortality and increased successful weaning rate.
Additional file Additional file 1: Table S1. Footnotes Competing interests All the authors declare that they have no competing interests. References 1. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery.
Crit Care Med. Prolonged mechanical ventilation in critically ill patients: epidemiology, outcomes and modelling the potential cost consequences of establishing a regional weaning unit. Crit Care. Outcomes of prolonged mechanic ventilation: a discrimination model based on longitudinal health insurance and death certificate data.
Tracheostomy practice in adults with acute respiratory failure. King C, Moores LK. Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med. Relationship between tracheotomy and ventilator-associated pneumonia: a case control study. Eur Respir J. Blot F, Melot C. Commission d'Epidemiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in French ICUs. Use of tracheostomy in the PICU among patients requiring prolonged mechanical ventilation.
Intensive Care Med. Timing of tracheostomy in critically ill patients: a meta-analysis. PloS One. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis.
Lancet Respir Med. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir care. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.
Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. The decision to extubate in the intensive care unit. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients.
Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: a randomized trial. Ann Intern med. Prolonged mechanical ventilation after cardiac surgery: outcome and predictors.
0コメント