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Indication and Timing

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Percutaneous Tracheostomy in Critically Ill Patients

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Abstract

Tracheostomy is performed in patients requiring prolonged mechanical ventilation aiming at avoiding the potential detrimental effect of a sustained translaryngeal intubation (e.g. laryngeal oedema, mucosal ulcerations). Potential benefits of tracheostomy in critically ill patients are improved comfort and reduced need for sedation, easier clearance of secretions and oral hygiene, and a possible faster weaning from mechanical ventilation. Controversy exists over optimal timing (early, tracheostomy placement compared with later time points) in patients with respiratory failure. Among the published randomised controlled trials, two large studies did not report a significant advantage of an early tracheostomy compared to a late procedure for the primary outcomes of incidence of ventilator-associated pneumonia and all-cause of mortality at 30 days from randomisation. In non-head injured blunt trauma patients with prolonged respiratory failure, tracheostomy placement after 7–10 days seems appropriate. This timing would avoid the potential procedural complications of an unnecessary procedure in patients with a possible shorter period of mechanical ventilation. Further investigations are needed for giving proper indication and timing of tracheostomy in selected populations (e.g. traumatic and non-traumatic neurologic injuries).

OverviewTracheostomy is the most common procedure performed in patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation [1]. For most indications and potential benefits of tracheostomy, high-quality evidence is lacking as it comes from clinical experience, observational studies and few controlled studies [1]. The best timing during the ICU stay for tracheostomy performance has been better investigated. Appropriate selection of patients and time for tracheostomy may enhance the potential benefits associated with this procedure [2].This chapter will focus on indication and timing of tracheostomy, providing the clinician information on the current level of evidence about the decision of whether and when to perform a tracheostomy in a critically ill ICU patient.

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Authors and Affiliations

  1. Section of Anesthesiology, Analgesia, Emergency and Intensive Care, Department of Biopathology and Medical Biotechnologies (DIBIMED), Policlinico “P. Giaccone”, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy

    Andrea Cortegiani, Vincenzo Russotto & Cesare Gregoretti

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  1. Andrea Cortegiani
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  2. Vincenzo Russotto
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  3. Cesare Gregoretti
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Correspondence to Andrea Cortegiani .

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Editors and Affiliations

  1. Neurosc, Reprod, Odontostomatol Sc, University of Naples “Federico II”, Naples, Italy

    Giuseppe Servillo

  2. Surgical Sc and Integrated Diagnostics, AOU IRCCS San Martino- IST University of Genoa, Genoa, Italy

    Paolo Pelosi

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Cortegiani, A., Russotto, V., Gregoretti, C. (2016). Indication and Timing. In: Servillo, G., Pelosi, P. (eds) Percutaneous Tracheostomy in Critically Ill Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-22300-1_3

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  • DOI: https://doi.org/10.1007/978-3-319-22300-1_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22299-8

  • Online ISBN: 978-3-319-22300-1

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