Papaioannou M, Vagiana E, Kotoulas SC, Sileli M, Manika K, Tsantos A, Kapravelos N. Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic. World J Methodol 2024; 14(2): 91868 [PMID: 38983661 DOI: 10.5662/wjm.v14.i2.91868]
Corresponding Author of This Article
Serafeim-Chrysovalantis Kotoulas, PhD, Consultant Physician-Scientist, Intensive Care Unit, Hippokration General Hospital, Kostantinoupoleos 49, Thessaloniki 54642, Greece. akiskotoulas@hotmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. Jun 20, 2024; 14(2): 91868 Published online Jun 20, 2024. doi: 10.5662/wjm.v14.i2.91868
Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic
Maria Papaioannou, Evdoxia Vagiana, Serafeim-Chrysovalantis Kotoulas, Maria Sileli, Katerina Manika, Alexandros Tsantos, Nikolaos Kapravelos
Maria Papaioannou, 1st Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
Evdoxia Vagiana, Maria Sileli, Nikolaos Kapravelos, 2nd Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
Serafeim-Chrysovalantis Kotoulas, Intensive Care Unit, Hippokration General Hospital, Thessaloniki 54642, Greece
Katerina Manika, Department of Pulmonary, Medical School, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
Alexandros Tsantos, 2nd Department of Internal Medicine, General Hospital of Thessaloniki “Ippokration”, Thessaloniki 54642, Greece
Author contributions: Papaioannou M and Vagiana E designed research; Vagiana E performed research; Manika K, Tsantos A, and Kapravelos N contributed new reagents or analytic tools; Kotoulas SC analyzed data; Papaioannou M, Sileli M, and Kotoulas SC wrote the paper; All authors contributed to the study, read and approved the final manuscript.
Institutional review board statement: All procedures performed in this study are in accordance with the ethical standards of the scientific council of the General Hospital of Thessaloniki “G. Papanikolaou”, reference number 1214.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors have no conflicts of interest to disclose.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Serafeim-Chrysovalantis Kotoulas, PhD, Consultant Physician-Scientist, Intensive Care Unit, Hippokration General Hospital, Kostantinoupoleos 49, Thessaloniki 54642, Greece. akiskotoulas@hotmail.com
Received: January 7, 2024 Revised: February 24, 2024 Accepted: April 12, 2024 Published online: June 20, 2024 Processing time: 158 Days and 16.5 Hours
Abstract
BACKGROUND
Tracheostomy is commonly used in intensive care unit (ICU) patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction. However, some studies have conflicting findings regarding the optimal technique and its timing and benefits.
AIM
To provide evidence of practice, characteristics, and outcome concerning tracheostomy in an ICU of a tertiary care hospital.
METHODS
This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years. Patients’ demographic characteristics, severity of illness (APACHE II score), level of consciousness [Glasgow Coma Scale (GCS)], comorbidities, timing and type of tracheostomy procedure performed and outcome were recorded. We defined late as tracheostomy placement after 8 days or no tracheotomy.
RESULTS
Data of 660 patients were analyzed (median age of 60 years), median APACHE II score of 19 and median GCS score of 12 at admission. Tracheostomy was performed in 115 patients, of whom 63 had early and 52 late procedures. Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy, however there were no significant statistical results (47.6% vs 36.5%, P = 0.23) and (23.8% vs 19.2%, P = 0.55) respectively. Regarding the method selected, early surgical tracheostomy (ST) was conducted in patients with maxillofacial injuries (50.0% vs 0.0%, P = 0.033), whereas late surgical tracheostomy was selected for patients with goiter (44.4% vs 0.0% P = 0.033). Patients with early tracheostomy spent significantly fewer days on mechanical ventilation (15.3 ± 8.5 vs 22.8 ± 9.6, P < 0.001) and in ICU in general (18.8 ± 9.1 vs 25.4 ± 11.5, P < 0.001). Percutaneous dilatation tracheostomy (PDT) vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission (62.5% vs 26.3%, P = 0.004). ST was the method of choice in compromised airway (31.6%, vs 7.3% P = 0.008). A large proportion of patients (88/115) with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU (100% vs 17.4%, P < 0.001).
CONCLUSION
PDT was performed more frequently in our cohort. This technique did not affect mechanical ventilation days, ventilator-associated pneumonia (VAP), ICU length of stay, or survival. No complications were observed in the percutaneous or surgical tracheostomy groups. Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status, presence of VAP, or survival.
Core Tip: Performing a tracheostomy in critical care patients is a common procedure. We analyzed patients who were hospitalized for two consecutive years in an intensive care unit in a tertiary hospital, before the coronavirus disease 2019 pandemic. We recorded our findings in this observational study, associated with the timing and method of tracheostomy, the role of tracheostomy in weaning from the mechanical ventilation and the outcome. Our findings were quite consistent with the review of literature, but need to be confirmed by prospective studies. We hope that this study could contribute to a certain degree to the literature about tracheostomy.
