Context & Objectives: Tracheostomy is often performed in ICU patients for prolonged
mechanical ventilation weaning or deficient airway protection. Guidelines are available but
many questions remain opened as optimal time and technique for tracheostomy or weaning
strategies. We aimed to analyse characteristics, treatments and outcome of patients
tracheostomized in the Lausanne ICU.
Methods: Retrospective analysis of patients tracheotomised in the Lausanne Adult ICU
between May 2017 and October 2018. Burn victims, patients tracheotomised prior to ICU stay
or for ENT (ear-nose-throat) reasons were excluded. Patients’ characteristics, ventilation and
sedation data, tracheostomy data and outcomes were collected from medical files. Global
population was analysed. Patients were also separated in three subgroups depending on
cause of intubation: respiratory, neurological and other cause of intubation. Descriptive data
shown as median [IQR].
Results: 80 patients (28.8% of women) were included, 28 in the “respiratory”, 23 in the
“neurological” and 29 in the “other” subgroups. For the whole population, median age was 60
[52 - 71] years. SAPS II score was 46 [39 - 62]. ICU mortality was 7.5% and hospital mortality
23.7%. Ventilation followed general guidelines before tracheostomy. Ventilation data reflected
worse pulmonary disease in the “other” and “respiratory” sub-groups, in particular in the latest.
Time from intubation to tracheostomy was 14.7 [10-20] days in the global population.
Tracheostomy was more often surgical than percutaneous and all patients were ventilated in
pressure-support ventilation 2 hours before tracheostomy. Concerning the sub-groups,
patients’ characteristics were relatively similar. Time from intubation to tracheostomy showed
a trend to be shorter in the “neurological” sub-group. ICU stay, hospital stay and time before
tracheostomy cannula ablation were also shorter in the “neurological” subgroup. Mortality
tended to be lower in the “neurological” sub-group and there was no death in the ICU for that
sub-group.
Conclusion:
This study confirms that hospital mortality in tracheostomized ICU patients is relatively high, at 23.7%. Overall, more surgical compared to percutaneous tracheostomies were performed in our ICU. Time from intubation to tracheostomy was 14.7 days. When comparing patients depending on cause of intubation, differences were found mainly in patients with neurological disease at admission. They stayed in the ICU and hospital for a shorter amount of time and were weaned from tracheostomy earlier.