The Effect of Delay Following the Clinical Decision to Perform Tracheostomy in the Critical Care Setting.
Background: Tracheostomy in patients who are critically ill is generally performed due to prolonged mechanical ventilation and expected extubation failure. However, tracheostomy criteria and ideal timing are poorly defined, including equivocal data from randomized controlled trials and median intuba...
| Publicado en: | Respiratory Care Vol. 69; no. 4; pp. 463 - 470 |
|---|---|
| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Apr2024
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=176385399&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 176385399 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Apr2024 vid: 69 iid: 4 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 176385399 176385399 176385399 10.4187/respcare.10916 176385399 ppf: 463 ppct: 7 formats: fmt: @attributes: type: P tig: atl: The Effect of Delay Following the Clinical Decision to Perform Tracheostomy in the Critical Care Setting. aug: au: Zimmerman, Frederic S. Shaul, Chanan Helviz, Yigal Levin, Phillip D. affil: Critical Care Unit, Shaare Zedek Medical Center, Jeusalem, Israel sug: subj: Treatment Delay Decision Making, Clinical Tracheostomy Adverse Effects Critical Care Critically Ill Patients Guardianship, Legal Respiratory Failure Therapy Human Intensive Care Units Retrospective Design Intention Extubation Adverse Effects Death Etiology Palliative Care Comparative Studies Nervous System Diseases Hospitalization Hospital Mortality Risk Factors Respiration, Artificial Prospective Studies Coding Descriptive Statistics Fisher's Exact Test Chi Square Test T-Tests Mann-Whitney U Test Data Analysis Software Male Female Middle Age Aged Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Tracheostomy in patients who are critically ill is generally performed due to prolonged mechanical ventilation and expected extubation failure. However, tracheostomy criteria and ideal timing are poorly defined, including equivocal data from randomized controlled trials and median intubation to tracheostomy times that range from 7-21 d. However, a consistent finding is that only -50% of late tracheostomy groups actually undergo tracheostomy, with non-performance due to recovery or clinical deterioration. Unlike in many jurisdictions, elective surgical procedures in our institution require a court-appointed guardian, which necessitates an approximately 1-week delay between the decision to perform tracheostomy and surgery. This offers a unique opportunity to observe patients with potential tracheostomy during a delay between the decision and the performance. Methods: ICU patients who were ventilated were identified for inclusion retrospectively by an application for guardianship relating to tracheostomy, the intention-to-treat point. The main outcomes of tracheostomy, extubation, or death/palliative care after inclusion were noted. Demographics, outcomes, and event timing were compared for the 3 outcome groups. Results: Tracheostomy-related guardianship requests were made for 388 subjects. Of these, 195 (50%) underwent tracheostomy, whereas 127 (33%) were extubated and 66 (17%) either died before tracheostomy (46 [12%]) or were transitioned to palliative care (20 [5%]). The median time (interquartile range) from guardianship request until a defining event was the following: 6.2 (4.0-11) d for tracheostomy, 5.0 (2.9-8.2) d for extubation (P < .001 as compared to tracheostomy group), and 6.5 (2.5-11) d for death/palliative care (P = .55 as compared to tracheostomy). Neurological admissions were more common in the tracheostomy group and less common in the palliative group. Other admission demographics and hospitalization characteristics were similar. Hospital mortality was higher for subjects undergoing tracheostomy (58/195 [30%]) versus extubation (24/127 [19%]) (P = .03). Conclusions: Delay in performing tracheostomy due to legal requirements was associated with a 50% decrease in the need for tracheostomy. This suggests that decision-making with regard to ideal tracheostomy timing could be improved, saving unnecessary procedures. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|