Early vs. late tracheotomy does not reduce mortality in ICU patients

May 18, 2010

Early tracheotomy in ICU patients on mechanical ventilation (MV) did not reduce mortality when compared to later tracheotomy in a study of cardiac surgery patients requiring prolonged ventilation in a Paris study.

The findings will be reported at the ATS 2010 International Conference in New Orleans.

Early percutaneous tracheotomy (EPT) in patients requiring prolonged MV remains controversial, as recent studies suggested it might shorten MV duration and lower mortality, while others have not.

"Based on the results of our study, early tracheotomy provided no benefit in terms of MV duration, hospital length of stay, mortality or frequency of infectious complications compared to prolonged intubation possibly followed by late tracheotomy," said researcher Alain Combes, M.D., Ph.D., professor at the Université Pierre et Marie Curie in Paris.

The single-center study randomized 216 adults still requiring MV 4𔃃 days after cardiac surgery, and projected to remain so for at least seven days, to receive early percutaneous tracheotomy or prolonged intubation (PI) with possible tracheotomy if lasted more than 15 days.

Characteristics of the two groups were similar at randomization, although the ET group had more heart transplant patients (21 versus 7 percent) and more patients requiring renal replacement therapy (38 versus 16 percent.) At the end, the number of ventilator-free days was lower in the EPT group, but the difference did not reach statistical significance. However, EPT was associated with less intravenous sedation and analgesia, fewer unscheduled extubations and less reintubations, and with earlier bed-to-chair transfer and resumption of oral nutrition.

"We expected MV duration reduction because tracheotomy was previously shown to reduce sedative and analgesics consumption, which is clearly associated with reduced MV duration and sometimes even with reduced ," said Dr. Combes. "We hypothesized that EPT might reduce MV duration by 6 days, but the true effect of EPT, if it exists, might only be a reduction of 2-3 days, which is not sufficiently clinically relevant, and might require 10 times as many patients for a study to demonstrate a significant effect."

Dr. Combes did, however, note that tracheotomy is associated with very rare but potential adverse events, like every invasive procedure. "To avoid unnecessary tracheostomies, physicians might consider them only after 7-10 days of MV, when projected MV duration is longer than one week at that time point," he concluded.

Explore further: Restrictions lifted at British bird flu farm

add to favorites email to friend print save as pdf

Related Stories

Measles virus may be effective prostate cancer treatment

Jan 21, 2009

A new study appearing in The Prostate has found that certain measles virus vaccine strain derivatives, including a strain known as MV-CEA, may prove to be an effective treatment for patients with advanced prostate cancer ...

Early mobilization of patients in ICU improves outcomes

May 18, 2009

Aside from the obvious and immediate health problems that patients undergoing mechanical ventilation face, those who recover often do so with profound loss of strength and mobility that can impair their daily functioning ...

Recommended for you

Restrictions lifted at British bird flu farm

19 hours ago

Britain on Sunday lifted all restrictions at a duck farm in northern England after last month's outbreak of H5N8 bird flu, the same strain seen in recent cases across Europe.

Recorded Ebola deaths top 7,000

Dec 20, 2014

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

Dec 20, 2014

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.