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Comparison of the duration of sedation between the ET group and the LT group. See Figure 1 legend for expansion of abbreviations.
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The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically ill patients who received an early or late tracheotomy.
A systematic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emb...
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Introduction
Chest x-rays (CXRs) are the most frequent radiological tests performed in the intensive care unit (ICU). However, the utility of performing daily routine CXRs is unclear.
Methods
We searched Medline and Embase (1948 to March 2011) for randomized and quasi-randomized controlled trials (RCTs) and before-after observational studies compa...
Citations
... niespójności w definicjach wahają się -od 24 godzin (ferraris et al. 2001), przez siedem dni (papuzinski et al. 2013), do ponad ośmiu dni (partik et al. 2003). W przeprowadzonych w ostatnich latach metaanalizach przyjęto siódmą dobę intubacji jako kryterium odcięcia definiujące wczesną i późną tracheotomię w grupie dorosłych pacjentów wymagających mechanicznej wentylacji (Griffiths et al. 2005;Wang et al. 2011). Stąd też należy traktować intubację jako przedłużoną, gdy trwa ona dłużej niż siedem dni. ...
Celem niniejszego artykułu jest przedstawienie czynników ryzyka wystąpienia dysfagii u chorych zakażonych wirusem SARS-CoV-2 na podstawie dostępnych źródeł, zarówno krajowych, jak i zagranicznych. Zaburzenia połykania są częstym objawem u pacjentów hospitalizowanych z powodu COVID-19. Wykazano, że dysfagia jest niezależnym predyktorem śmiertelności wewnątrzszpitalnej, przedłużonego czasu hospitalizacji oraz wiąże się z niekorzystnym rokowaniem u tych chorych. W związku z tym poznanie mechanizmów i czynników powodujących zaburzenia połykania jest bardzo ważne i powinno być dobrze poznane. Etiologia dysfagii w przebiegu COVID-19
jest wieloczynnikowa. Zarówno obecność czynników ryzyka ciężkiego przebiegu infekcji, zmiany zachodzące w organizmie na skutek choroby oraz stosowane leczenie mogą stanowić przyczynę trudności w połykaniu.
Summary
The aim of this article is to present the risk factors for dysphagia in patients infected with SARS-CoV-2 based on available sources, both domestic and foreign. Swallowing disorders are a common symptom among patients hospitalised for COVID-19. Dysphagia has been shown to be an independent predictor of in-hospital mortality, prolonged hospitalisation, and is associated with an unfavourable prognosis in these patients. Therefore, learning about the mechanisms and factors causing swallowing disorders is very important and should be well understood. The aetiology of dysphagia in COVID-19 is multifactorial. Both the presence of risk factors for progression to severe infection, changes in the body as a result of the disease, and the treatment used can account for swallowing difficulties.
... Our data are consistent with current literature, which shows no significant association between timing of tracheostomy and mortality. 15,16,21 ...
... However, prolonged ventilation with endotracheal intubation brings about numerous complications. [2] In recent years, the percutaneous tracheostomy technique has become the method of choice for tracheostomy in cases of prolonged intubation in intensive care units. The percutaneous dilatation technique has been associated with lower incidence of complications such as bleeding and wound infection compared to surgical tracheostomy. ...
Aim: Tracheostomy is a common procedure performed surgically or percutaneously due to prolonged intubation. During the procedure, airway safety can be ensured using a laryngeal mask airway (LMA) or an endotracheal tube (ETT). The aim of this study was to investigate the complications associated with the use of LMA and ETT during the tracheostomy procedure, operative time, and changes in blood gas parameters. Materials and Methods: This study included patients admitted to the Intensive Care Units of Burdur State Hospital between 2019 and 2023. A total of 78 patients were divided into two groups: ETT (n=39) and LMA (n=39). Procedure-related complications, operative time, blood gas data were recorded from the patient files. Results: There was no statistically significant difference between the LMA and ETT groups in terms of complications. There was also no statistically significant difference in postoperative values of PaCO2 between the groups (p
... The timing of tracheostomy insertion remains debated. Multiple studies examining 'early' versus 'late' tracheostomy prior to Covid-19 fail to show mortality benefits, and although some studies suggest a decrease in ventilator associated pneumonia, several large studies and meta-analyses dispute this (18,(20)(21)(22)(23)(24)(25)(26)(27). The definition of 'early' is not categorical, with trial definitions varying from 48 hours to 10 days (17,18,22,23,28,29). ...
Background:
Tracheostomy insertion in patients with coronavirus disease 2019 (COVID-19) presents unique challenges. Patients frequently have high ventilatory requirements, and as an aerosol generating procedure, tracheostomy insertion creates the potential for staff transmission. Problems with tracheostomies contribute to morbidity and mortality, and tracheostomy changes may increase risks of staff transmission. We sought to quantify the incidence of clinically necessitated tracheostomy changes, establish the indications for change and investigate the incidence of staff transmission.
Methods:
We conducted a single institution, retrospective, observational cohort study of all intensive care unit (ICU) patients with COVID-19 who had a tracheostomy between March 2020 and April 2021. The institution is a large tertiary referral centre in Ireland.
Results:
Forty-three patients had a tracheostomy during the study period. All were a Shiley™ Flexible Adult Taperguard or Shiley™ XLT Tracheostomy. 14 patients (33%) required a tracheostomy change, with the majority (57%) involving a change from a standard size to an extended length tracheostomy. Persistent leak was the most common indication for change (71.6%). Other indications included patient-ventilator dyssynchrony, persistent cough and accidental decannulation. No staff transmission of COVID-19 occurred during this study.
Conclusions:
The incidence of tracheostomy change was 33%, highlighting the importance of selecting the right tracheostomy for each patient. We discuss how key characteristics of tracheostomies such as type, size, length and inner diameter may impact flow, resistance and work of breathing, leading to unplanned tracheostomy change. No staff transmission occurred arising from tracheostomy insertion, adding to increasing evidence that tracheostomy insertion in COVID-19 appears safe with adherence to guidelines describing the correct use of personal protective equipment.
... 12 One more meta-analysis showed that with early tracheostomy there was no decrease in length of ICU stay, ventilation or sedation.There was also no improvement in incidence of VAP and mortality. 13 The TracMan study which included 909 patients in 87 UK hospitals found no difference in antibiotic use, VAP rates and ICU stay but a moderate reduction in sedation requirement in the early tracheostomy group. The mortality rates were similar at 30 days and 2 years post-randomisation. ...
Tracheostomy is one of the oldest surgical procedures and its technique has evolved over time. Nearly half of all tracheostomies are performed in the ICU. Most of these tracheostomies are temporary. Percutaneous dilatational tracheostomy (PDT) has become a standard practice in intensive care unit (ICU). However, many aspects of its practice are not yet clear. This bedside procedure when performed by experienced intensivists is reasonably safe but has known complications. In this review, the basics of tracheostomy, indications, contraindications, various techniques, complications, the assisting aids for PDT and the operator competence required are discussed. Finally PDT is compared with surgical tracheostomy and the feasibility of PDT in patients with coagulopathy, obesity and on high PEEP is reviewed
... 12 One more meta-analysis showed that with early tracheostomy there was no decrease in length of ICU stay, ventilation or sedation.There was also no improvement in incidence of VAP and mortality. 13 The TracMan study which included 909 patients in 87 UK hospitals found no difference in antibiotic use, VAP rates and ICU stay but a moderate reduction in sedation requirement in the early tracheostomy group. The mortality rates were similar at 30 days and 2 years post-randomisation. ...
... Da eine prolongierte translaryngeale Intubation zu Schäden des Kehlkopfs und subglottischen Stenosen führt [119,120,121] und die Entwöhnung vom Beatmungsgerät erschweren kann, wird bei Patienten mit zu erwartender Langzeitbeatmung in der Regel nach 7 bis 10 Tagen eine dilatative oder plastische Tracheotomie durchgeführt. In 2 Metaanalysen und einer randomisierten Studie bestand hinsichtlich der Pneumonieinzidenz zwischen frühzeitiger und späterer Tracheotomie kein signifikanter Unterschied [122]. Von früher Tracheotomie spricht man bei Durchführung des Eingriffs am 3. bis 4. Beatmungstag; von später Tracheotomie ab dem 7. Beatmungstag [123]. ...
... Von früher Tracheotomie spricht man bei Durchführung des Eingriffs am 3. bis 4. Beatmungstag; von später Tracheotomie ab dem 7. Beatmungstag [123]. Die frühzeitige Tracheotomie kann allerdings zu einer kürzeren Beatmungs-und Intensivbehandlungsdauer führen [122,124,125]. ...
... Even in patients without COVID-19, recommendations for tracheostomy are controversial. The optimal timing of tracheostomy has been discussed extensively but the definition of clear guidelines was not possible because meta-analyses and reviews show mixed results concerning general outcome parameters of early (≤ 10 days from intubation to tracheostomy (ITT)) vs. late (> 10 days) tracheostomy [12][13][14][15] . The classification as early tracheostomy also shows a wide variability, however, an ITT ≤ 10 days is repeatedly used in reviews and meta-analyses [16][17][18] . ...
... With an increased mortality hazard ratio when performing tracheostomy at day 10 or earlier, early tracheostomy appears to worsen patient outcome in COVID-19. This is rather surprising, as we expected a benefit or at least non-inferiority of early tracheostomy for our patients, because studies in patients with or without COVID-19 infection scarcely indicated increased mortality in patients undergoing early tracheostomy [12][13][14][15][16][17][18]41,43 . Our data appear to indicate that delaying tracheostomy may in fact benefit our patients. ...
COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed their operating procedures and performed an early tracheostomy. We studied the data on early and delayed tracheostomy regarding patient outcome such as mortality. We performed a retrospective analysis of all tracheostomies at our institution in patients diagnosed with COVID-19 from March 2020 to June 2021. Time from intubation to tracheostomy and mortality of early (≤ 10 days) vs. late (> 10 days) tracheostomy were the primary objectives of this study. We used mixed cox-regression models to calculate the effect of distinct variables on events. We studied 117 tracheostomies. Intubation to tracheostomy shortened significantly (Spearman’s correlation coefficient; rho = − 0.44, p ≤ 0.001) during the course of this pandemic. Early tracheostomy was associated with a significant increase in mortality in uni- and multivariate analysis (Hazard ratio 1.83, 95% CI 1.07–3.17, p = 0.029). The timing of tracheostomy in COVID-19 patients has a potentially critical impact on mortality. The timing of tracheostomy has changed during this pandemic tending to be performed earlier. Future prospective research is necessary to substantiate these results.
... However, tracheostomy is associated with bleeding, wound infection, tracheal stenosis, accidental displacement, and occasionally death. 3 The timing of tracheostomy in a mechanically ventilated patient is a clinically important question in ICU practice; several studies have attempted to answer this, including several metaanalyses. 2e6 Deng and colleagues 4 completed a recent metaanalysis based on RCTs to investigate whether early tracheostomy compared with late tracheostomy can improve clinical outcomes in critically ill patients undergoing mechanical ventilation. ...
Background
A recent systematic review and meta-analysis of RCTs of early vs late tracheostomy in mechanically ventilated patients suggest that early tracheostomy reduces the duration of ICU stay and mechanical ventilation, but does not reduce short-term mortality or ventilator-associated pneumonia (VAP). Meta-analysis of randomised trials is typically performed using a frequentist approach, and although reporting confidence intervals, interpretation is usually based on statistical significance. To provide a robust basis for clinical decision-making, we completed the search used from the previous review and analysed the data using Bayesian methods to estimate posterior probabilities of the effect of early tracheostomy on clinical outcomes.
Methods
The search was completed for RCTS comparing early vs late tracheostomy in the databases PubMed, EMBASE, and Cochrane library in June 2022. Effect estimates and 95% confidence intervals were calculated for the outcomes short-term mortality, VAP, duration of ICU stay, and mechanical ventilation. A Bayesian meta-analysis was performed with uninformative priors. Risk ratios (RRs) and standardised mean differences (SMDs) with 95% credible intervals were reported alongside posterior probabilities for any benefit (RR<1; SMD<0), a small benefit (number needed to treat, 200; SMD<–0.5), or modest benefit (number needed to treat, 100; SMD<–1).
Results
Nineteen RCTs with 3508 patients were included. Comparing patients with early vs late tracheostomy, the posterior probabilities for any benefit, small benefit, and modest benefit, respectively, were: 99%, 99%, and 99% for short-term mortality; 94%, 78%, and 51% for VAP; 97%, 43%, and 1% for duration of mechanical ventilation; and 97%, 75%, and 27% and for length of ICU stay.
Conclusions
Bayesian meta-analysis suggests a high probability that early tracheostomy compared with delayed tracheostomy has at least some benefit across all clinical outcomes considered.
... 1,2 Likewise, meta-analyses involving a mixed critical care population have shown similar conflicting results. [3][4][5] Previous findings are further complicated by the variable definitions of "early" and "late" tracheostomy in the literature, with some studies defining tracheostomy within 3 and 10 days and >7 to 10 days from initiation of mechanical ventilation as early and late, respectively. 6 Nonetheless, studies specifically looking at patients with severe head injuries have demonstrated that early tracheostomy may result in lower mortality [7][8][9] and reduced ICU length of stay. ...
... This is congruent with another large retrospective study showing increased survival with tracheostomy following severe TBI (Glasgow Coma Scale [GCS] 8). 15 Accurately predicting the timing of tracheostomy placement in TBI patients secondary to prolonged mechanical ventilation is challenging, though some studies have shown lower mortality, shorter ICU/hospital length of stay, and fewer complications with ET. 3,7,16 Due to disparities in definitions of ET in the literature, the unknown severity and pathological location of TBI, and variable concomitant injuries, caution should be exercised in comparing our findings with previously published literature. Nevertheless, previous studies have shown conflicting results in short-and long-term mortality following ET vs LT in patients with severe head injuries. ...
Tracheostomy following severe traumatic brain injury (TBI) is common, yet the outcomes associated with tracheostomy timing are unclear. The objective of this study was to assess hospital outcomes of tracheostomy timing in TBI patients. We retrospectively analyzed data from the National Inpatient Sample database of adult patients aged ≥18 years with a primary diagnosis of TBI. Indexed hospitalizations of TBI patients who underwent either percutaneous or surgical tracheostomy between 1995 and 2015 in the United States were included. The interventional groups were 1) early tracheostomy (≤7 days) vs standard tracheostomy (8-14 days), vs late tracheostomy (≥15 days), and 2) tracheostomy vs no tracheostomy. Propensity score matching and conditional logistic regression models were used to analyze in-hospital mortality, length of hospitalization, and in-hospital complications among TBI patients in relation to tracheostomy timing. The risk of in-hospital mortality was 35% lower in patients who underwent tracheostomy vs those who did not (odds ratio 0.65; P < 0.001). Patients who underwent early tracheostomy had a higher risk of in-hospital mortality compared to standard tracheostomy (odds ratio 1.69; P < 0.001) or late tracheostomy (odds ratio 1.80; P < 0.001). An early tracheostomy was associated with a shorter mean hospital length of stay (27 days) compared to standard (36 days) or late tracheostomy (48 days).
