Tracheostomy procedures in the intensive care unit: an international survey

Maria Vargas, Yuda Sutherasan, Massimo Antonelli, Iole Brunetti, Antonio Corcione, John G Laffey, Christian Putensen, Giuseppe Servillo, Paolo Pelosi, Maria Vargas, Yuda Sutherasan, Massimo Antonelli, Iole Brunetti, Antonio Corcione, John G Laffey, Christian Putensen, Giuseppe Servillo, Paolo Pelosi

Abstract

Introduction: 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.

Figures

Fig. 1
Fig. 1
Distribution of different tracheostomies shown as the total number performed in and outside Europe. *Statistically significant. MDT multiple dilation tracheostomy, SSDT single-step dilation tracheostomy, GWDF guidewire dilating forceps, RDT rotational dilation tracheostomy, BDT balloon dilation tracheostomy, TLT translaryngeal tracheostomy, ST surgical tracheostomy

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