Outcome using a conservative tracheostomy strategy in intensive care.
OBJECTIVE
We have a conservative approach to tracheostomy in intensive care, in that every patient considered for tracheostomy in our unit is discussed at a clinical meeting to evaluate potential benefit and harm from the procedure. This study examined tracheostomy numbers, complications and outcome of patients who had tracheostomy in comparison to our general intensive care population and to Scottish national data.


METHODS
We collected prospective data on all patients having a tracheostomy over a three year period. Data included included time to tracheostomy, type of procedure (open or percutaneous), ventilator settings immediately before tracheostomy, peri- and post-operative complications and mortality.


RESULTS
The number of tracheostomies was low (27 of 692 patients, 4%) and time to tracheostomy high (mean, 18 days) in comparison to published data. Patients who had a tracheostomy had a hospital mortality that was greater than predicted by the APACHE II scoring system (55% actual mortality vs. 44% predicted). Standardised mortality ratio (SMR) was 1.29 for tracheostomy patients and 0.89 for patients who did not have a tracheostomy. Length of stay and mortality were similar to national figures. One patient in the tracheostomy group developed tracheal stenosis that needed surgical intervention. There were no cases of symptomatic tracheal stenosis in the much larger group managed with orotracheal intubation alone.


CONCLUSIONS
We found that a conservative approach to performing tracheostomy reduced the number of procedures performed without affecting overall unit outcomes.
Khanna
R
R
Department of Anaesthesia and Critical Care, Stobhill Hospital, Balornock Rd, Glasgow G21 3UW, UK.
Beynon
J A
JA
Ure
D S
DS
D018806:APACHE; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012606:Scotland; D014139:Tracheostomy / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome