Tracheotomy in the intensive care unit: guidelines from a French expert panel

doi:10.1186/s13613-018-0381-y

Review

. 2018 Mar 15;8(1):37.

doi: 10.1186/s13613-018-0381-y.

Tracheotomy in the intensive care unit: guidelines from a French expert panel

Jean Louis Trouillet¹, Olivier Collange^{2

3}, Fouad Belafia⁴, François Blot⁵, Gilles Capellier^{6

7}, Eric Cesareo^{8

9}, Jean-Michel Constantin^{10

11}, Alexandre Demoule¹², Jean-Luc Diehl^{13

14}, Pierre-Grégoire Guinot^{15

16}, Franck Jegoux¹⁷, Erwan L'Her^{18

19}, Charles-Edouard Luyt^{1

20}, Yazine Mahjoub²¹, Julien Mayaux¹², Hervé Quintard^{22

23}, François Ravat²⁴, Sebastien Vergez²⁵, Julien Amour²⁶, Max Guillot^{27

28}

Affiliations

¹ Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
² Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.
³ EA 3072, FMTS, Université de Strasbourg, Strasbourg, France.
⁴ Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France.
⁵ Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France.
⁶ CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.
⁷ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia.
⁸ SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
⁹ Lyon Sud School of Medicine, University Lyon 1, Oullins, France.
¹⁰ Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
¹¹ R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France.
¹² INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France.
¹³ Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.
¹⁴ INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France.
¹⁵ Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
¹⁶ INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.
¹⁷ Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France.
¹⁸ CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.
¹⁹ Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France.
²⁰ UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France.
²¹ Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France.
²² Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.
²³ CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France.
²⁴ Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France.
²⁵ ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France.
²⁶ Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
²⁷ EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. max.guillot@chru-strasbourg.fr.
²⁸ Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France. max.guillot@chru-strasbourg.fr.

PMID: 29546588
PMCID: PMC5854567
DOI: 10.1186/s13613-018-0381-y

Review

Tracheotomy in the intensive care unit: guidelines from a French expert panel

Jean Louis Trouillet et al. Ann Intensive Care. 2018.

. 2018 Mar 15;8(1):37.

doi: 10.1186/s13613-018-0381-y.

Authors

Affiliations

¹ Service de Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
² Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Pôle d'Anesthésie-Réanimation Chirurgicale, SAMU, SMUR, NHC, 1 Place de l'Hôpital, 67000, Strasbourg, France.
³ EA 3072, FMTS, Université de Strasbourg, Strasbourg, France.
⁴ Intensive Care Unit and Department of Anesthesiology, Research Unit INSERM U1046, University of Montpellier Saint Eloi Hospital and Montpellier School of Medicine, Montpellier, France.
⁵ Medical-Surgical Intensive Care Unit, Gustave Roussy Cancer Campus, Villejuif, France.
⁶ CHRU Besançon 25000, EA3920 Université de Franche-Comté, Besançon, France.
⁷ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia.
⁸ SAMU de Lyon and Department of Emergency Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
⁹ Lyon Sud School of Medicine, University Lyon 1, Oullins, France.
¹⁰ Department of Preoperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
¹¹ R2D2, EA-7281, Auvergne University, Clermont-Ferrand, France.
¹² INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Sorbonne Université, Paris, France.
¹³ Medical ICU, AP-HP, Georges Pompidou European Hospital, Paris, France.
¹⁴ INSERM UMR-S1140, Paris Descartes University and Sorbonne Paris Cité, Paris, France.
¹⁵ Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
¹⁶ INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.
¹⁷ Service ORL et Chirurgie Cervico-maxillo-Faciale, CHU PONTCHAILLOU, Rue H. Le Guilloux, 35033, Rennes Cedex 9, France.
¹⁸ CeSim/LaTIM INSERM UMR 1101, Université de Bretagne Occidentale, Rue Camille Desmoulins, 29200, Brest Cedex, France.
¹⁹ Médecine Intensive et Réanimation, CHRU de Brest, Boulevard Tanguy Prigent, 29200, Brest Cedex, France.
²⁰ UPMC Université Paris 06, INSERM, UMRS-1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Universités, Paris, France.
²¹ Department of Anesthesia and Intensive Care, Amiens-Picardie University Hospital, Amiens, France.
²² Réanimation médico chirurgicale Hôpital Pasteur 2 CHU de Nice, 30 voie romaine, 06000, Nice, France.
²³ CNRS UMR 7275, IPMC Sophia Antipolis, Valbonne, France.
²⁴ Centre des brûlés, Centre Hospitalier St Joseph et St Luc, 20 quai Claude Bernard, 69007, Lyon, France.
²⁵ ORL Chirurgie Cervicofaciale, CHU Toulouse Rangueil-Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France.
²⁶ Département d'Anesthésie et de Réanimation Chirurgicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
²⁷ EA 3072, FMTS, Université de Strasbourg, Strasbourg, France. max.guillot@chru-strasbourg.fr.
²⁸ Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Réanimation Médicale, Avenue Molière, 67200, Strasbourg, France. max.guillot@chru-strasbourg.fr.

PMID: 29546588
PMCID: PMC5854567
DOI: 10.1186/s13613-018-0381-y

Abstract

Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Société de Réanimation de Langue Française) and the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation) with the participation of the French Emergency Medicine Association (Société Française de Médecine d'Urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1+/-) and 6 a low level of proof (Grade 2+/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced.

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Figures

**Fig. 1**
Proposal for a protocol associated with guideline 3.5 (Expert opinion)

**Fig. 2**
Proposal for a protocol associated with guideline 3.5 (Expert opinion)

**Fig. 3**
Proposed care protocol associated with guideline 4.1 (Expert opinion)

**Fig. 4**
Proposed endoscopic protocol associated with guideline 5.1 (Expert opinion): *(according to Warnecke* et al. Crit Care Med 2013 (106))

See this image and copyright information in PMC

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References

1. Blot F, Melot C. Commission d’Epidémiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127(4):1347–1352. - PubMed
1. Freeman BD, Kennedy C, Coopersmith CM, Buchman TG. Examination of non-clinical factors affecting tracheostomy practice in an academic surgical intensive care unit. Crit Care Med. 2009;37(12):3070–3078. doi: 10.1097/CCM.0b013e3181bc7b96. - DOI - PubMed
1. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890–2896. doi: 10.1097/CCM.0b013e31825bc948. - DOI - PubMed
1. Banfi P, Robert D. Early tracheostomy or prolonged translaryngeal intubation in the ICU: a long running story. Respir Care. 2013;58(11):1995–1996. doi: 10.4187/respcare.02875. - DOI - PubMed
1. Durbin CG. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056–1068. - PubMed

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[1] Blot F, Melot C. Commission d’Epidémiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127(4):1347–1352. - PubMed

[2] Blot F, Melot C. Commission d’Epidémiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127(4):1347–1352. - PubMed

[3] Freeman BD, Kennedy C, Coopersmith CM, Buchman TG. Examination of non-clinical factors affecting tracheostomy practice in an academic surgical intensive care unit. Crit Care Med. 2009;37(12):3070–3078. doi: 10.1097/CCM.0b013e3181bc7b96. - DOI - PubMed

[4] Freeman BD, Kennedy C, Coopersmith CM, Buchman TG. Examination of non-clinical factors affecting tracheostomy practice in an academic surgical intensive care unit. Crit Care Med. 2009;37(12):3070–3078. doi: 10.1097/CCM.0b013e3181bc7b96. - DOI - PubMed

[5] Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890–2896. doi: 10.1097/CCM.0b013e31825bc948. - DOI - PubMed

[6] Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40(10):2890–2896. doi: 10.1097/CCM.0b013e31825bc948. - DOI - PubMed

[7] Banfi P, Robert D. Early tracheostomy or prolonged translaryngeal intubation in the ICU: a long running story. Respir Care. 2013;58(11):1995–1996. doi: 10.4187/respcare.02875. - DOI - PubMed

[8] Banfi P, Robert D. Early tracheostomy or prolonged translaryngeal intubation in the ICU: a long running story. Respir Care. 2013;58(11):1995–1996. doi: 10.4187/respcare.02875. - DOI - PubMed

[9] Durbin CG. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056–1068. - PubMed

[10] Durbin CG. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056–1068. - PubMed

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Tracheotomy in the intensive care unit: guidelines from a French expert panel

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Tracheotomy in the intensive care unit: guidelines from a French expert panel

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