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Utilization and outcomes of tracheostomies in the intensive care unit in Iceland in 2007-2020: a descriptive study

Acta Anaesthesiol Scand. 2022 Jun 15. doi: 10.1111/aas.14105. Online ahead of print.


BACKGROUND: Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction or surgery in the face/neck region. However, practices regarding timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period.

METHODS: A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007-2020. Data was retrieved from hospital charts on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression.

RESULTS: A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was nine days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%, and one-and five-year mortality rate was 40% and 60%, respectively.

CONCLUSIONS: We describe a whole-nation practice of tracheostomies. A notable finding is the relatively uncommon attempts of extubation prior to tracheostomy. Future work should focus on standardization in assessing the need for tracheostomy, including various patient characteristics and the role of extubation attempts prior to tracheostomy placement.

PMID:35704855 | DOI:10.1111/aas.14105

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