Role of tracheotomy in ventilator - Article Example

Download file to see previous pages Tracheotomy is commonly performed for critically ill, ventilator-dependent patients to provide long-term airway access. The benefits commonly ascribed to tracheotomy, compared to prolonged translaryngeal intubation, include improved patient comfort, more effective airway suctioning, decreased airway resistance, enhanced patient mobility, increased opportunities for articulated speech, ability to eat orally, and a more secure airway. Conceptually, these advantages might result in fewer ventilator complications (eg, ventilator-associated pneumonia), accelerated weaning from mechanical ventilation, and the ability to transfer ventilator-dependent patients from the ICU. Concern, however, exists about the risks associated with the procedure and the costs involved. The impact of tracheotomy on the duration of mechanical ventilation and on ICU outcomes in general has been examined by several different study designs, none of them ideal. Most studies are retrospective, although a few prospective studies have been performed. A serious problem is that many studies assigned patients to treatment groups on the basis of physician practice patterns rather than random assignment. Those studies that used random assignment frequently used quasi-randomization methods (eg, every other patient, every other day, hospital record number, or odd-even days). Studies have compared patients undergoing tracheotomy vs those not undergoing tracheotomy, and patients undergoing early tracheotomy vs those undergoing late tracheotomy....
decreased airway resistance, enhanced patient mobility,
increased opportunities for articulated speech, ability
to eat orally, and a more secure airway. Conceptually,
these advantages might result in fewer ventilator complications
(eg, ventilator-associated pneumonia), accelerated
weaning from mechanical ventilation, and the ability to
transfer ventilator-dependent patients from the ICU. Concern,
however, exists about the risks associated with the
procedure and the costs involved.
The impact of tracheotomy on the duration of mechanical
ventilation and on ICU outcomes in general has been
examined by several different study designs, none of them
ideal. Most studies are retrospective, although a few
prospective studies have been performed. A serious problem
is that many studies assigned patients to treatment
groups on the basis of physician practice patterns rather
than random assignment. Those studies that used random
assignment frequently used quasi-randomization methods
(eg, every other patient, every other day, hospital record
number, or odd-even days). Studies have compared patients
undergoing tracheotomy vs those not undergoing
tracheotomy, and patients undergoing early tracheotomy
vs those undergoing late tracheotomy. The definition of
early vs late tracheotomy varies between studies. "Early"
may be defined as a period as short as 2 days after the start
of mechanical ventilation to as late as 10 days after the
start.
Patient populations included in studies also vary widely
between investigations and include general surgical and
medical patients in some studies and specific patient
groups (eg, trauma patients or head-injured patients) in
other studies. Most studies have design flaws in the
collection and analysis of data, foremost of which ...Download file to see next pagesRead More