Monday, April 17, 2006

Percutaneous trachs

Have you had much experience or come across data on percutaneous (vs open surgical) trachs in you persistent respiratory failure ICU patients?

2 comments - CLICK HERE to read & add your own!:

Mike L said...

I have not seen any articles showing a benefit of one vs. the other.
Another equally intriguing question is when to peform a tracheostomy.
There is no data showing improved patient comfort, no difference pulmonary mechanics, respiratory rate, minute ventilation, tidal volume or airway resistance.
Davis, K Jr, et al. Arch Surg. 1999;134:59-62
Lin, et al. Anaesth Intensive Care. 1999 Dec;27(6):581-5

So, how do you decide when to ask your ENT surgeon to see a patient?

Jeff H said...

As for the percutaneous trach, I have no direct experience, but every intensivist I've known who has done them has eventually stopped doing them and deferred to surgeons. And most surgeons I've encountered prefer the OR.

I think a lot if it has to do with how "service oriented" the surgeons at your institution are. If they can have a trach done expeditiously, then it's probably the best use of your time and resources to let them do it (unless you don't have enough other stuff to keep you busy on a day-to-day basis...).

As to early vs. late, there are some data favoring early trach placement in outcomes such as ICU LOS, time on MV, and even mortality. But, in the one study I've seen, the results were so one-sided as to really make me question if they could be possible!