Tracheostomy protocol: experience with development and potential utility.
Crit Care Med
; 36(6): 1742-8, 2008 Jun.
Article
em En
| MEDLINE
| ID: mdl-18496369
ABSTRACT
OBJECTIVES:
To examine the feasibility and potential utility of a tracheostomy protocol based on a standardized approach to ventilator weaning.DESIGN:
Prospective, observational data collection.SETTING:
Academic medical center. PATIENTS Surgical intensive care unit patients requiring mechanical ventilatory support.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Tracheostomy practice in 200 patients was analyzed in relation to spontaneous breathing trial (SBT) weaning. Decision for, and performance of, tracheostomy occurred (median [interquartile range]) 5.0 (3.75-8.0) and 7.0 (5.0-10.0) days following initiation of mechanical ventilation, respectively. Duration of mechanical ventilation was greater in tracheostomy compared with nontracheostomy patients (15.0 [11.0-19.0] vs. 6.0 [4.0-8.0], p < .001). For patients requiring ventilatory support for > or = 20 days, 100% of patients were maintained via tracheostomy. A protocol based on weaning performance, which included technical considerations, was developed. Individuals who failed preliminary weaning assessment or SBT for 3 successive days following 5 days (nonreintubated patients) or 3 days (reintubated patients) of ventilatory support met tracheostomy criteria. The protocol was implemented on a pilot basis in 125 individuals. Of the 55 (44.0%) patients undergoing tracheostomy, 25 (45.5%) did so consistent with criteria. Eighteen patients (32.7%) underwent tracheostomy before the time interval of data collection targeting weaning protocol performance, and 12 patients (21.8%) passed SBT on one or more occasions, were not extubated, and proceeded to tracheostomy.CONCLUSIONS:
A standardized approach in which the decision for tracheostomy is based on objective measures of weaning performance may be a means of using this procedure more consistently and effectively.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Traqueostomia
/
Desmame do Respirador
/
Procedimentos Clínicos
/
Cuidados Críticos
Tipo de estudo:
Guideline
/
Observational_studies
/
Prognostic_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article