Tracheostomy procedures in the intensive care unit: an international survey.
BACKGROUND
Percutaneous dilatational tracheostomy (PDT) is one of the most frequent procedures performed in the intensive care unit (ICU). PDT may add potential benefit to clinical management of critically ill patients. Despite this, no clinical guidelines are available. We sought to characterize current practice in this international survey.


METHODS
An international survey, endorsed and peer reviewed by European Society of Intensive Care Medicine (ESICM), was carried out from May to October 2013. The questionnaire was accessible from the ESICM website in the 'survey of the month' section.


RESULTS
429 physicians from 59 countries responded to this survey. Single step dilatational tracheostomy was the most used PDT in ICU. Almost 75% of PDT's were performed by intensive care physicians. The main indication for PDT was prolonged mechanical ventilation. Tracheostomies were most frequently performed between 7-15 days after ICU admission. Volume control mechanical ventilation, and a combination of sedation, analgesia, neuromuscular blocking agents and fiberoptic bronchoscopy were used. Surgical tracheostomy was mainly performed in ICU by ENT specialists, and was generally chosen when for patients at increased risk for difficult PDT insertion. Bleeding controlled by compression and stoma infection/inflammation were the most common intra-procedural and late complications, respectively. Informed consent for PDT was obtained in only 60% of cases.


CONCLUSIONS
This first international picture of current practices in regard to tracheostomy insertion demonstrates considerable geographic variation in practice, suggesting a need for greater standardization of approaches to tracheostomy insertion.
Department of Neurosciences, Odonthostomatological and Reproductive Sciences, University of Naples, "Federico II", Naples, Italy. vargas.marai82@gmail.com.
Maria
M
Vargas
Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 RAMA VI road, Bangkok, 10400, Thailand. sutherasan_yuda@yahoo.com.
Yuda
Y
Sutherasan
Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy. m.antonelli@rm.unicatt.it.
Massimo
M
Antonelli
Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Largo Rosanna Benzi 8, Genoa, 16131, Italy. ibrunetti@tin.it.
Iole
I
Brunetti
AORN Ospedale dei Colli, Naples, Italy. corcio.ant@libero.it.
Antonio
A
Corcione
Department of Anesthesia, Critical Illness and Injury Research Centre, Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, Canada. laffeyj@smh.ca.
John G
JG
Laffey
University of Bonn, Bonn, Germany. Christian.Putensen@ukb.uni-bonn.de.
Christian
C
Putensen
Department of Neurosciences, Odonthostomatological and Reproductive Sciences, University of Naples, "Federico II", Naples, Italy. servillo@unina.it.
Giuseppe
G
Servillo
Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Largo Rosanna Benzi 8, Genoa, 16131, Italy. ppelosi@hotmail.com.
Paolo
P
Pelosi
D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014139:Tracheostomy / Q000379:methods / Q000706:statistics & numerical data*