Néstor Raimondi1, Macarena R Vial2, José Calleja3, Agamenón Quintero4, Albán Cortés5, Edgar Celis6, Clara Pacheco7, Sebastián Ugarte8, José M Añón9, Gonzalo Hernández10, Erick Vidal11, Guillermo Chiappero12, Fernando Ríos13, Fernando Castilleja3, Alfredo Matos14, Enith Rodriguez14, Paulo Antoniazzi15, José Mario Teles16, Carmelo Dueñas17, Jorge Sinclair18, Lorenzo Martínez19, Ingrid von der Osten20, José Vergara21, Edgar Jiménez22, Max Arroyo23, Camilo Rodríguez4, Javier Torres24, Sebastián Fernandez-Bussy25, Joseph L Nates26. 1. Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina. 2. MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile. 3. Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México. 4. Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia. 5. Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile. 6. Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia. 7. Hospital Universitario de Caracas, Caracas, Venezuela. 8. Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile. 9. Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain. 10. Complejo Hospitalario de Toledo, Toledo, Spain. 11. Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México. 12. Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina. 13. Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina. 14. Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá. 15. Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil. 16. Hospital de Urgências de Goiânia, Goiás, Brazil. 17. Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia. 18. Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá. 19. Hospital Policlínica Metropolitana, Caracas, Venezuela. 20. Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela. 21. Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador. 22. Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA. 23. Clínica Santa Sofía, Caracas, Venezuela. 24. Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile. 25. Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL. 26. MD Anderson Cancer Center, The University of Texas, Houston, TX, USA. Electronic address: jlnates@mdanderson.org.
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.
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: Christopher Ull; Christina Weckwerth; Uwe Hamsen; Oliver Jansen; Aileen Spieckermann; Thomas Armin Schildhauer; Robert Gaschler; Christian Waydhas Journal: Eur J Trauma Emerg Surg Date: 2022-10-13 Impact factor: 2.374
Authors: Jörn Grensemann; Lars Eichler; Sophie Kähler; Dominik Jarczak; Marcel Simon; Hans O Pinnschmidt; Stefan Kluge Journal: Crit Care Date: 2017-12-29 Impact factor: 9.097
Authors: Christopher P Michetti; Clay Cothren Burlew; Eileen M Bulger; Kimberly A Davis; David A Spain Journal: Trauma Surg Acute Care Open Date: 2020-04-15