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Outcome using a conservative tracheostomy strategy in intensive care
R Khanna1, J A Beynon, D S Ure
1Department of Anaesthesia and Critical Care, Stobhill Hospital, Balornock Rd, Glasgow G21 3UW, UK.
Scottish Medical Journal
|December 2, 2006
Summary
A conservative intensive care approach to tracheostomy reduced procedure rates without impacting patient outcomes. This strategy involved careful evaluation of potential benefits and harms for each patient considered for tracheostomy.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
Background:
- Intensive care units (ICUs) often face decisions regarding tracheostomy.
- A conservative approach involves rigorous evaluation of tracheostomy benefits versus risks.
Purpose of the Study:
- To examine tracheostomy rates, complications, and patient outcomes in an ICU with a conservative approach.
- To compare these findings with the general ICU population and national data.
Main Methods:
- Prospective data collection over three years for all tracheostomy patients.
- Data included timing, procedure type, pre-tracheostomy ventilator settings, complications, and mortality.
Main Results:
- Low tracheostomy rate (4%) and delayed timing (mean 18 days) compared to literature.
- Tracheostomy patients had higher actual mortality (55%) than predicted (44% APACHE II).
- One case of tracheal stenosis occurred in the tracheostomy group; none in the orotracheal intubation group.
Conclusions:
- A conservative strategy for tracheostomy in intensive care significantly reduces procedure numbers.
- This approach did not negatively affect overall unit outcomes or mortality.
- Careful patient selection is key to managing tracheostomy use effectively.
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