Tracheostomy Applications in a Medical Intensive Care Unit: Timing, Indications, and Outcomes

Tracheostomy in a Medical ICU

Abstract

Background: This study aimed to determine the timing, indications, and mortality associated with tracheostomy through the evaluation of the data obtained from a medical ICU.

Materials and Methods: We retrospectively evaluated the data of the patients who underwent tracheostomy at an internal medicine ICU of a university hospital between January 01, 2012, and December 31, 2015. After determining the general characteristics of the patients, we compared the data of the patients who survived or died, underwent percutaneous (PT) or a surgical tracheostomy (ST) and early (ET) or a late tracheostomy (LT).

Findings: A total of 91 patients were included in the study. The median age of the patients was 72 years, tracheostomy was performed on the median 16th day after the ICU admission. Tracheostomy was most commonly performed due to prolonged mechanical ventilation (93.4%). The surgical method was the most commonly preferred tracheostomy technique (79.1%). When the 16 patients (17.6%) who survived tracheostomy were evaluated, they were found to be younger and there was a shorter time between the ICU admission and tracheostomy procedure. This study also demonstrated that the preferred tracheostomy technique (PT or ST) did not affect early or late tracheostomy complications, the length of ICU stay, infection rate, and ICU mortality. Additionally, ET or LT had no effect on ICU mortality, however; patients who underwent ET had a shorter ICU stay.

Conclusions: Tracheostomy is the most common invasive procedure performed in ICUs. However, there is still no consensus regarding the timing and method. An ICU specialist should decide the necessity of tracheostomy based on the patients’ needs.