Author(s): Marchese S, Corrado A, Scala R, Corrao S, Ambrosino N Intensive C,
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Abstract BACKGROUND: Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transferred to respiratory ICU (RICU). Indications/timing for closing tracheostomy are discussed. AIM AND METHOD: We report results of a one-year survey evaluating: 1) clinical characteristics, types of tracheostomy, complications in patients admitted to Italian RICU in 2006; 2) clinical criteria and systems for performing decannulation, and outcome of patients undergoing tracheostomy (number decannulated; number non-decannulated/non-ventilated; number non-decannulated/ventilated; dead/lost patients). RESULTS: 22/32 RICUs replied. There were 846 admissions of 719 patients (Mean age 64,3 (+/-14.2) years, 489 (68\%) males). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24.4\%); exacerbation of Chronic Obstructive Pulmonary Disease 222 (34.4\%); neuromuscular diseases 200 (27.8\%); surgical patients 77 (10.7\%); thoracic dysmorphism 28 (3.8\%); obstructive sleep apnea syndrome 16 (2.2\%). Percutaneous tracheostomies were 65.9\%. Major complications after tracheostomy were 2\%. 427 tracheostomies were evaluated for decannulation: 96 (22.5\%) were closed; 175 patients (41\%) were discharged with home mechanical ventilation; 114 patients (26.5\%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10\%) died or lost. The clinical criteria chosen for decannulation were: stability of respiratory conditions, effective cough, underlying diseases and ability to swallow. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube; laryngo-tracheoscopy; use of tracheal button and down-sizing. CONCLUSIONS: There were few major complications of tracheostomy. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation. There was no agreement on indications and systems for closing tracheostomy.
This article was published in Respir Med
and referenced in Journal of Sleep Disorders & Therapy