The role of tracheotomy in weaning from prolonged mechanical ventilation

Abstract

Patients with trauma often require mechanical ventilation for prolonged periods because of their inability to protect their airways, persistence of excessive secretions and inadequacy of spontaneous ventilation. Tracheostomy is often performed in patients with prolonged translaryngeal intubation on ventilatory support. Its role in weaning from mechanical ventilation remains however subject to practice variation. This was a prospective study at Kenyatta National Hospital Intensive Care Unit (ICU) of patients admitted with trauma to determine the prevalence, timing and outcomes of patients done tracheostomy. Glasgow coma score (GCS) was used to assess severity of illness. All trauma patients 13 years and above with GCS of 8 and below and mechanically ventilated were followed until successfully weaned off the ventilatory support. For patients on whom tracheostomy was performed, the timing of the tracheostomy was noted. Tracheostomy was considered early if it was done before 14 days and late if it was done after 14 days on the ventilatory support. The technique of tracheostomy was also noted. Analysis was made to compare patients who had tracheostomy and those who did not have tracheostomy to establish if tracheostomy accelerates the weaning process in patients with anticipated prolonged ventilatory' support. Further analysis was also made to compare early and late Tracheostomy to 8 establish if early tracheostomy is associated with faster rate of weaning compared to late tracheostomy. This study was conducted for a period of six months starting from November 1st 2005 to April 30th 2006. Of a total of 108 trauma patients admitted to the ICU, initiated on mechanical ventilation and recruited into the study, tracheostomy was performed on 28 patients (17%). Comparing patients done to those not done tracheostomy, p value<0.005, patients done tracheostomy were found to have been weaned faster off mechanical ventilation. Comparing early (1-14 days) tracheostomy to late (>14 days), early was associated with shorter duration of mechanical ventilation, p-value <0.015.