Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery.
In maxillofacial head and neck oncology, tracheostomy is often used to secure the airway, but not without risk. This study compared the existing practice of two units: one where tracheostomy was routinely done with one where overnight intubation was used. From both units we retrospectively analysed 50 consecutive patients who had intraoral resection, neck dissection, and microvascular reconstruction for head and neck cancer. When compared with tracheostomy, overnight intubation resulted in a shorter mean stay in the intensive therapy unit (ITU) (1.4 compared with 3.7 days), a shorter overall hospital stay (12.9 compared with 18.0 days), less time to first oral intake (8.9 compared with 12.8 days), and a lower rate of lower respiratory tract infection (LRTI) (10% compared with 38%). This study supports the discontinuation of routine tracheostomy and the adoption of a more selective practice to improve recovery.
Department of Oral and Maxillofacial Surgery, Frenchay Hospital, North Bristol NHS Trust, Frenchay Park Road, Bristol BS16 1LE, UK. coylem@eircom.net
Margaret J
MJ
Coyle
Robert
R
Tyrrell
Andrew
A
Godden
Ceri W
CW
Hughes
Charles
C
Perkins
Steve
S
Thomas
Daryl
D
Godden
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000379:methods*; D003422:Critical Care; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D011182:Postoperative Care; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology*; D012141:Respiratory Tract Infections / Q000517:prevention & control; D012189:Retrospective Studies; D014139:Tracheostomy; D055815:Young Adult
Airway management; Enhanced patient recovery; Oral and maxillofacial oncology; Overnight intubation; Tracheostomy