Early versus Late Tracheostomy for Intubated Patients in Intensive Care Units

Shkar Nazar Mohammed; Saleh Ahmed  Tawfique; Hiwa Asaad  Abdulkareem

doi:10.56056/amj.2019.88

Authors

Shkar Nazar Mohammed MBChB, KHCMS(ENT) trainee ENT, Head & Neck surgery – Sulaimani Teaching Hospital
Saleh Ahmed Tawfique FRCS-FRCSEd-DLO-SB, ENT head and neck surgery professor, senior consultant surgeon, Erbil training center
Hiwa Asaad Abdulkareem MBCHB-FICMS-CABS, ENT head and neck surgery assistant 94 professor, senior consultant surgeon, Sulamani teaching hospital ENT head and neck surgery center

DOI:

https://doi.org/10.56056/amj.2019.88

Keywords:

Mechanical ventilation in intensive care unit, Tracheostomy, Prolonged endotracheal intubation

Abstract

Background and objectives:Tracheostomy, is an integral component of the management plan for the critically ill patients admitted in the intensive care unit under endotracheal intubation. However, there is controversy regarding the effects of timing of tracheostomy in those patients, which was the purpose of this prospective study.

Methods:A-sample of 48 cases were selected, based on timing of tracheostomy they were assigned into 2 groups: early trache ostomy group; included 24 patients that were intubated for less than 10 days and within this 10 days tracheostomies were performed, and late tracheostomy group in which patients remained on endotracheal intubation for more than 10 days and then tracheostomies were performed. Collected data included; postoperative vital signs, chest X-Rays of the patients, condition of the tracheostomy tubes, any morbidity & mortality and complications that ensued.

Results: Out of 24 cases in the early tracheostomy group, only 7 of them were associated with lung haziness in the postoperative chest X-Rays, while lung haziness was found in chest X-Rays of 14 out of total 24 cases which was more than half of the sample in the late tracheostomy study group, showing higher rates of ventilator associated pneumonia in late tracheostomy group compared to early tracheostomy group.

Conclusions:Late tracheostomy associated with a higher risk of ventilator associated pneumonia. It’s advised not to leave patients with endotracheal intubation tube for more than 10 days in intensive care units.

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