Jatinder Grewal1,2, Anna-Liisa Sutt2,3, George Cornmell4, Kiran Shekar2,3,4,5, John Fraser2,3,4. 1. 3883Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia. 2. Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia. 3. University of Queensland, Brisbane, Queensland, Australia. 4. Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia. 5. Bond University, Gold Coast, Queensland, Australia.
Abstract
PURPOSE: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. METHODS: Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. RESULTS: Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose (P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference (P value = .46) in the amount of PRC used post-TT. CONCLUSIONS: These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.
PURPOSE: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. METHODS: Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. RESULTS: Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose (P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference (P value = .46) in the amount of PRC used post-TT. CONCLUSIONS: These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.
Authors: Ismael A Salas De Armas; Kha Dinh; Bindu Akkanti; Pushan Jani; Reshma Hussain; Lisa Janowiak; Kayla Kutilek; Manish K Patel; Mehmet H Akay; Rahat Hussain; Jayeshkumar Patel; Chandni Patel; Yafen Liang; John Zaki; Biswajit Kar; Igor D Gregoric Journal: J Extra Corpor Technol Date: 2020-12