A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study

Introduction: We investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS). Methods: Randomized...

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Autores: Díaz Prieto, Antonio, Mateu, Antoni, Gorriz, Maite, Ortiga, Berta, Truchero, Consol, Sampietro, Neus, Ferrer, María Jesus, Máñez Mendiluce, Rafael
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2014
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/126357
Acceso en línea:https://hdl.handle.net/2445/126357
Access Level:acceso abierto
Palabra clave:Traqueotomia
Respiració artificial
Tracheotomy
Artificial respiration
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spelling A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center studyDíaz Prieto, AntonioMateu, AntoniGorriz, MaiteOrtiga, BertaTruchero, ConsolSampietro, NeusFerrer, María JesusMáñez Mendiluce, RafaelTraqueotomiaRespiració artificialTracheotomyArtificial respirationIntroduction: We investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS). Methods: Randomized controlled trial (RCT) including all-consecutive ICU admitted patients requiring seven or more days of MV. Between days five to seven of MV, before randomization, the attending physician (AP) was consulted about the expected duration of MV and acceptance of tracheotomy according to randomization. Only accepted patients received tracheotomy as result of randomization. An intention to treat analysis was performed including patients accepted for the AP and those rejected without exclusion criteria. Results: A total of 489 patients were included in the RCT. Of 245 patients randomized to the early group, the procedure was performed for 167 patients (68.2%) whereas in the 244 patients randomized to the late group was performed for 135 patients (55.3%) (P <0.004). Mortality at day 90 was similar in both groups (25.7% versus 29.9%), but duration of sedation was shorter in the early tracheotomy group median 11 days (range 2 to 92) days compared to 14 days (range 0 to 79) in the late group (P <0.02). The AP accepted the protocol of randomization in 205 cases (42%), 101 were included in early group and 104 in the late group. In these subgroup of patients (per-protocol analysis) no differences existed in mortality at day 90 between the two groups, but the early group had more ventilator-free days, less duration of sedation and less LOS, than the late group. Conclusions: This study shows that early tracheotomy reduces the days of sedation in patients undergoing MV, but was underpowered to prove any other benefit. In those patients selected by their attending physicians as potential candidates for a tracheotomy, an early procedure can lessen the days of MV, the days of sedation and LOS. However, the imprecision of physicians to select patients who will require prolonged MV challenges the potential benefits of early tracheotomy.BioMed Central2018201820142018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion11 p.application/pdfapplication/pdfhttps://hdl.handle.net/2445/126357Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1186/s13054-014-0585-yCritical Care, 2014, vol. 18, num. 5https://doi.org/10.1186/s13054-014-0585-ycc by (c) Díaz Prieto et al., 2014http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1263572026-05-29T05:05:01Z
dc.title.none.fl_str_mv A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
title A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
spellingShingle A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
Díaz Prieto, Antonio
Traqueotomia
Respiració artificial
Tracheotomy
Artificial respiration
title_short A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
title_full A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
title_fullStr A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
title_full_unstemmed A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
title_sort A randomized clinical trial for the timing of tracheotomy in critically ill patients: factors precluding inclusion in a single center study
dc.creator.none.fl_str_mv Díaz Prieto, Antonio
Mateu, Antoni
Gorriz, Maite
Ortiga, Berta
Truchero, Consol
Sampietro, Neus
Ferrer, María Jesus
Máñez Mendiluce, Rafael
author Díaz Prieto, Antonio
author_facet Díaz Prieto, Antonio
Mateu, Antoni
Gorriz, Maite
Ortiga, Berta
Truchero, Consol
Sampietro, Neus
Ferrer, María Jesus
Máñez Mendiluce, Rafael
author_role author
author2 Mateu, Antoni
Gorriz, Maite
Ortiga, Berta
Truchero, Consol
Sampietro, Neus
Ferrer, María Jesus
Máñez Mendiluce, Rafael
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Traqueotomia
Respiració artificial
Tracheotomy
Artificial respiration
topic Traqueotomia
Respiració artificial
Tracheotomy
Artificial respiration
description Introduction: We investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS). Methods: Randomized controlled trial (RCT) including all-consecutive ICU admitted patients requiring seven or more days of MV. Between days five to seven of MV, before randomization, the attending physician (AP) was consulted about the expected duration of MV and acceptance of tracheotomy according to randomization. Only accepted patients received tracheotomy as result of randomization. An intention to treat analysis was performed including patients accepted for the AP and those rejected without exclusion criteria. Results: A total of 489 patients were included in the RCT. Of 245 patients randomized to the early group, the procedure was performed for 167 patients (68.2%) whereas in the 244 patients randomized to the late group was performed for 135 patients (55.3%) (P <0.004). Mortality at day 90 was similar in both groups (25.7% versus 29.9%), but duration of sedation was shorter in the early tracheotomy group median 11 days (range 2 to 92) days compared to 14 days (range 0 to 79) in the late group (P <0.02). The AP accepted the protocol of randomization in 205 cases (42%), 101 were included in early group and 104 in the late group. In these subgroup of patients (per-protocol analysis) no differences existed in mortality at day 90 between the two groups, but the early group had more ventilator-free days, less duration of sedation and less LOS, than the late group. Conclusions: This study shows that early tracheotomy reduces the days of sedation in patients undergoing MV, but was underpowered to prove any other benefit. In those patients selected by their attending physicians as potential candidates for a tracheotomy, an early procedure can lessen the days of MV, the days of sedation and LOS. However, the imprecision of physicians to select patients who will require prolonged MV challenges the potential benefits of early tracheotomy.
publishDate 2014
dc.date.none.fl_str_mv 2014
2018
2018
2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/126357
url https://hdl.handle.net/2445/126357
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/s13054-014-0585-y
Critical Care, 2014, vol. 18, num. 5
https://doi.org/10.1186/s13054-014-0585-y
dc.rights.none.fl_str_mv cc by (c) Díaz Prieto et al., 2014
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Díaz Prieto et al., 2014
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 11 p.
application/pdf
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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