title: Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study.
abstract: IntroductionTracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity.ObjectiveThe objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country.MethodsThis study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months.ResultsThe indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis.ConclusionProlonged endotracheal intubation is the man indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Mohammad Waheed
authors.initials: MW
authors.lastname: El-Anwar
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmad Abdel-Fattah
authors.initials: AA
authors.lastname: Nofal
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Mohammad A El
authors.initials: MA
authors.lastname: Shawadfy
authors.affiliation: Department of Anesthesia and Intensive Care Units, School of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Maaty
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Zagazig University, Zagazig, Egypt.
authors.forename: Alaa Omar
authors.initials: AO
authors.lastname: Khazbak
keywords: ICU; endotracheal intubation; mechanical ventilation; tracheostomy