Tracheostomy in patients with long-term mechanical ventilation: a survey

Area of Science:

• Pulmonology
• Critical Care Medicine
• Surgical Procedures

Background:

• Tracheostomy is a common procedure in intensive care units (ICU), with many patients subsequently transferred to respiratory ICUs (RICUs).
• This study addresses the indications and timing for tracheostomy closure in a RICU setting.

Purpose of the Study:

• To evaluate clinical characteristics, tracheostomy types, and complications in Italian RICU patients in 2006.
• To assess clinical criteria, decannulation systems, and outcomes for patients undergoing tracheostomy.

Main Methods:

• A one-year survey of 22 Italian RICUs involving 719 patients admitted in 2006.
• Data collected included patient demographics, reasons for admission, tracheostomy type, complications, and decannulation outcomes.

Main Results:

• Percutaneous tracheostomies accounted for 65.9%, with major complications in 2% of cases.
• Of 427 tracheostomies evaluated, 22.5% were closed, 41% were discharged with home mechanical ventilation, and 26.5% maintained tracheostomy despite weaning.
• Criteria for decannulation included respiratory stability, effective cough, and swallowing ability, with varied evaluation methods.

Conclusions:

• Major complications from tracheostomy are infrequent.
• A significant number of patients continue to use tracheostomy tubes even when mechanical ventilation is no longer required.
• There is a notable lack of agreement on the indications and methods for tracheostomy closure among RICUs.