Evidence-based guidelines for the use of tracheostomy in critically ill patients
Date
2017
Type:
Artículo
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15
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ORCID:
Journal Title
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Volume Title
Publisher
Elsevier
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Abstract
Objectives
To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.
Methods
A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system.
Results
The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions.
Conclusions
Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
Description
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Citation
Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL; FEPIMCTI and LACCTIN. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017 Apr;38:304-318
Keywords
Tracheostomy, Clinical guidelines, Consensus, Percutaneous, Critical care, Intensive care unit