Tracheostomy in ventilator dependent trauma patients

A prospective, randomized intention-to-treat study

Erik S. Barquist, Jose Amortegui, Ali Hallal, Giovanni Giannotti, Robb Whinney, Heythem Alzamel, Jana MacLeod, Michael L Hawkins, Michael Rhodes, Carl J. Hauser

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Tracheostomy is a commonly performed procedure in ventilator dependent patients. Many critical care practitioners believe that performing a tracheostomy early in the postinjury period decreases the length of ventilator dependence as well as having other benefits such as better patient tolerance and lower respiratory dead space. We conducted a randomized, prospective, single institution study comparing the length ventilator dependence in critically ill multiple trauma patients who were randomized to two different strategies for performance of a tracheostomy. We hypothesized that earlier tracheostomy would reduce the number of days of mechanical ventilation, frequency of pneumonia and length of intensive care unit (ICU) stay. Methods: Patients were eligible if they were older than 15 years and either a Glasgow Coma Score (GCS) >4 with a negative brain computed tomography (CT) (no anatomic head injury), or a GCS >9 with a positive head CT (known anatomic head injury). Patients who required tracheostomy for facial/neck injuries were excluded. Patients were randomized to an intention to treat strategy of tracheostomy placement before day 8 or after day 28. Results: The study was halted after the first interim analysis. There were 60 enrolled patients, who had comparable demographics between groups. There was no significant difference between groups in any outcome variable including length of ventilator support, pneumonia rate, or death. Conclusion: A strategy of tracheostomy before day 8 postinjury in this group of trauma patients did not reduce the number of days of mechanical ventilation, frequency of pneumonia or ICU length of stay as compared with the group with a tracheostomy strategy involving the procedure at 28 days postinjury or more.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume60
Issue number1
DOIs
StatePublished - Jan 1 2006

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Tracheostomy
Mechanical Ventilators
Wounds and Injuries
Pneumonia
Coma
Craniocerebral Trauma
Artificial Respiration
Intensive Care Units
Respiratory Dead Space
Tomography
Facial Injuries
Neck Injuries
Multiple Trauma
Critical Care
Critical Illness
Length of Stay
Head
Demography
Mortality
Brain

Keywords

  • Critical illness
  • Intensive care units
  • Prolonged intubation
  • Randomized trial
  • Respiratory insufficiency/therapy
  • Tracheostomy
  • Trauma
  • Treatment outcome

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Tracheostomy in ventilator dependent trauma patients : A prospective, randomized intention-to-treat study. / Barquist, Erik S.; Amortegui, Jose; Hallal, Ali; Giannotti, Giovanni; Whinney, Robb; Alzamel, Heythem; MacLeod, Jana; Hawkins, Michael L; Rhodes, Michael; Hauser, Carl J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 60, No. 1, 01.01.2006, p. 91-97.

Research output: Contribution to journalArticle

Barquist, ES, Amortegui, J, Hallal, A, Giannotti, G, Whinney, R, Alzamel, H, MacLeod, J, Hawkins, ML, Rhodes, M & Hauser, CJ 2006, 'Tracheostomy in ventilator dependent trauma patients: A prospective, randomized intention-to-treat study', Journal of Trauma - Injury, Infection and Critical Care, vol. 60, no. 1, pp. 91-97. https://doi.org/10.1097/01.ta.0000196743.37261.3f
Barquist, Erik S. ; Amortegui, Jose ; Hallal, Ali ; Giannotti, Giovanni ; Whinney, Robb ; Alzamel, Heythem ; MacLeod, Jana ; Hawkins, Michael L ; Rhodes, Michael ; Hauser, Carl J. / Tracheostomy in ventilator dependent trauma patients : A prospective, randomized intention-to-treat study. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 60, No. 1. pp. 91-97.
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N2 - Background: Tracheostomy is a commonly performed procedure in ventilator dependent patients. Many critical care practitioners believe that performing a tracheostomy early in the postinjury period decreases the length of ventilator dependence as well as having other benefits such as better patient tolerance and lower respiratory dead space. We conducted a randomized, prospective, single institution study comparing the length ventilator dependence in critically ill multiple trauma patients who were randomized to two different strategies for performance of a tracheostomy. We hypothesized that earlier tracheostomy would reduce the number of days of mechanical ventilation, frequency of pneumonia and length of intensive care unit (ICU) stay. Methods: Patients were eligible if they were older than 15 years and either a Glasgow Coma Score (GCS) >4 with a negative brain computed tomography (CT) (no anatomic head injury), or a GCS >9 with a positive head CT (known anatomic head injury). Patients who required tracheostomy for facial/neck injuries were excluded. Patients were randomized to an intention to treat strategy of tracheostomy placement before day 8 or after day 28. Results: The study was halted after the first interim analysis. There were 60 enrolled patients, who had comparable demographics between groups. There was no significant difference between groups in any outcome variable including length of ventilator support, pneumonia rate, or death. Conclusion: A strategy of tracheostomy before day 8 postinjury in this group of trauma patients did not reduce the number of days of mechanical ventilation, frequency of pneumonia or ICU length of stay as compared with the group with a tracheostomy strategy involving the procedure at 28 days postinjury or more.

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