Evidence-based guidelines for the use of tracheostomy in critically ill patients.

Abstract

OBJECTIVES:

To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.

METHODS:

A taskforce 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 taskforce 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 6 questions.

CONCLUSIONS:

Percutaneous techniques are associated with a lower risk of infections compared with 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: Néstor Raimondi, Macarena R Vial, José Calleja, Agamenón Quintero, Albán Cortés, Edgar Celis, Clara Pacheco, Sebastián Ugarte, José M Añón, Gonzalo Hernández, Erick Vidal, Guillermo Chiappero, Fernando Ríos, Fernando Castilleja, Alfredo Matos, Enith Rodriguez, Paulo Antoniazzi, José Mario Teles, Carmelo Dueñas, Jorge Sinclair, Lorenzo Martínez, Ingrid von der Osten, José Vergara, Edgar Jiménez, Max Arroyo, Camilo Rodríguez, Javier Torres, Sebastián Fernandez-Bussy, Joseph L Nates, FEPIMCTI and LACCTIN
• Journal: Journal of critical care (J Crit Care) Vol. 38 Pg. 304-318 (04 2017) ISSN: 1557-8615 [Electronic] United States
• PMID: 28103536 (Publication Type: Consensus Development Conference, Journal Article, Practice Guideline)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Advisory Committees
• Critical Care
• Critical Illness (therapy)
• Evidence-Based Medicine
• Health Care Costs
• Humans
• Length of Stay
• Pneumonia (epidemiology)
• Respiration, Artificial (methods)
• Societies, Medical
• Time Factors
• Tracheostomy (economics, methods)