Evidence-based guides in tracheostomy use in critical patients

Abstract

Objectives: Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research.

Methods: A task force 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 task force 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 six questions.

Conclusion: Percutaneous techniques are associated with a lower risk of infections compared to 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.

Keywords: Clinical guides; Consenso; Consensus; Critical patient; Guías clínicas; Intensive care unit; Intensive treatment unit; Paciente crítico; Percutaneous; Percutánea; Tracheostomy; Traqueostomía; Unidad de cuidados intensivos; Unidad de terapia intensiva.