title: Evidence-based guides in tracheostomy use in critical patients.
abstract: OBJECTIVE
  Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.
  
  
  METHODS
  A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system.
  
  
  RESULTS
  The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions.
  
  
  CONCLUSIONS
  Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
authors.affiliation: Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Argentina.
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authors.lastname: Raimondi
authors.affiliation: MD Anderson Cancer Center, The University of Texas, Texas, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: M R
authors.initials: MR
authors.lastname: Vial
authors.affiliation: Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México.
authors.forename: J
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authors.lastname: Calleja
authors.affiliation: Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia.
authors.forename: A
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authors.lastname: Quintero
authors.affiliation: Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile.
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authors.lastname: Cortés Alban
authors.affiliation: Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia.
authors.forename: E
authors.initials: E
authors.lastname: Celis
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
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authors.affiliation: Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile.
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authors.lastname: Ugarte
authors.affiliation: Hospital Universitario la Paz -Carlos III. IdiPaz, Madrid, España.
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authors.initials: JM
authors.lastname: Añón
authors.affiliation: Complejo Hospitalario de Toledo, Toledo, España.
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authors.lastname: Hernández
authors.affiliation: Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México.
authors.forename: E
authors.initials: E
authors.lastname: Vidal
authors.affiliation: Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: G
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authors.lastname: Chiappero
authors.affiliation: Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina.
authors.forename: F
authors.initials: F
authors.lastname: Ríos
authors.affiliation: Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México.
authors.forename: F
authors.initials: F
authors.lastname: Castilleja
authors.affiliation: Complejo Hospitalario Caja de Seguro Social, Panamá.
authors.forename: A
authors.initials: A
authors.lastname: Matos
authors.affiliation: Complejo Hospitalario Caja de Seguro Social, Panamá.
authors.forename: E
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authors.lastname: Rodriguez
authors.affiliation: Hospital Santa Casa, Ribeirao Preto, Sao Paulo, Brazil.
authors.forename: P
authors.initials: P
authors.lastname: Antoniazzi
authors.affiliation: Hospital de Urgências de Goiânia, Goiás, Brazil.
authors.forename: J M
authors.initials: JM
authors.lastname: Teles
authors.affiliation: Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Dueñas
authors.affiliation: Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá.
authors.forename: J
authors.initials: J
authors.lastname: Sinclair
authors.affiliation: Hospital Policlínica Metropolitana, Caracas, Venezuela.
authors.forename: L
authors.initials: L
authors.lastname: Martínez
authors.affiliation: Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: I
authors.initials: I
authors.lastname: Von der Osten
authors.affiliation: Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES", Guayaquil, Ecuador.
authors.forename: J
authors.initials: J
authors.lastname: Vergara
authors.affiliation: Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas, Estados Unidos.
authors.forename: E
authors.initials: E
authors.lastname: Jiménez
authors.affiliation: Clínica Santa Sofía, Caracas, Venezuela.
authors.forename: M
authors.initials: M
authors.lastname: Arroyo
authors.affiliation: Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia.
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: J
authors.initials: J
authors.lastname: Torres
authors.affiliation: Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, Estados Unidos.
authors.forename: S
authors.initials: S
authors.lastname: Fernandez-Bussy
authors.affiliation: MD Anderson Cancer Center, The University of Texas, Texas, United States. Electronic address: jlnates@mdanderson.org.
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authors.initials: JL
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mesh_terms: D001999:Bronchoscopy; D002056:Burns / Q000628:therapy; D003422:Critical Care / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D017214:Laryngeal Masks; D007902:Length of Stay; D012121:Respiration, Artificial; D013119:Spinal Cord Injuries / Q000628:therapy; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods
keywords: Clinical guides; Consenso; Consensus; Critical patient; Guías clínicas; Intensive care unit; Intensive treatment unit; Paciente crítico; Percutaneous; Percutánea; Tracheostomy; Traqueostomía; Unidad de cuidados intensivos; Unidad de terapia intensiva