open access

Vol 48, No 2 (2016)
Original and clinical articles
Published online: 2016-03-15
Submitted: 2015-10-24
Accepted: 2016-02-13
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Early versus late tracheostomy in cardiovascular intensive care patients

Wilfredo Puentes, Angela Jerath, George Djaiani, Rosa Cabrerizo Sanchez, Marcin Wąsowicz
DOI: 10.5603/AIT.a2016.0016
·
Anaesthesiol Intensive Ther 2016;48(2):89-94.

open access

Vol 48, No 2 (2016)
Original and clinical articles
Published online: 2016-03-15
Submitted: 2015-10-24
Accepted: 2016-02-13

Abstract

Background: Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population.

Methods: After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as “early” if < 7 days or “late” if ≥ 7 days post-cardiac surgery).

Results: 14,101 patients underwent cardiac surgery over the 7-year study period; from those, 147 (1.36%) received tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P=0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups.

Conclusions: There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.

Abstract

Background: Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population.

Methods: After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as “early” if < 7 days or “late” if ≥ 7 days post-cardiac surgery).

Results: 14,101 patients underwent cardiac surgery over the 7-year study period; from those, 147 (1.36%) received tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P=0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups.

Conclusions: There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.

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Keywords

cardiac surgery, intensive care, tracheostomy, prolonged mechanical ventilation

About this article
Title

Early versus late tracheostomy in cardiovascular intensive care patients

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 48, No 2 (2016)

Pages

89-94

Published online

2016-03-15

DOI

10.5603/AIT.a2016.0016

Bibliographic record

Anaesthesiol Intensive Ther 2016;48(2):89-94.

Keywords

cardiac surgery
intensive care
tracheostomy
prolonged mechanical ventilation

Authors

Wilfredo Puentes
Angela Jerath
George Djaiani
Rosa Cabrerizo Sanchez
Marcin Wąsowicz

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