Prolonged intubation vs. tracheotomy: complications, practical and psychological considerations.
The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious. Sixty critical-care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety-two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required. We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.
Astrachan
D I
DI
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.
Kirchner
J C
JC
Goodwin
W J
WJ
D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000451:nursing / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009726:Nurses; D013997:Time Factors; D014140:Tracheotomy / Q000009:adverse effects* / Q000451:nursing / Q000706:statistics & numerical data