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. 2023 Mar 18;23(1):59.
doi: 10.1186/s12893-023-01960-5.

Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

Daniel J Nyanzi  1   2   3 , Daniel Atwine  4   5 , Ronald Kamoga  6 , Caroline Birungi  4 , Caroline A Nansubuga  7 , Victoria Nyaiteera  5 , Doreen Nakku  5
Affiliations

Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

Daniel J Nyanzi et al. BMC Surg. .

Abstract

Background: Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda.

Methods: In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h post-tracheostomy procedure. At baseline, information on patients' socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7 days follow-up. Comparison of patients' baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson's chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software.

Results: All patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 - 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR = 1.8, 95%CI: 1.19 - 2.76), Bjork flap tracheal incision (RR = 1.6, 95%CI: 1.09 - 2.43), vertical tracheal incision (RR = 1.53, 95%CI: 1.02 - 2.27), and age below 18 years (RR = 1.22, 95%CI: 1.00 - 1.47).

Conclusion: Pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.

Keywords: Early complications; Incidence; Indication; Pre-Covid-19; Tracheostomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Johnson R, Milan B, Casselbrant E. Bailey's Head and Neck Surgery - otolaryngology. 5 ed. Philadelphia Lippinkott Williams and Wilkins; 2014.
    1. Abe T, Madotto F, Pham T, Nagata I, Uchida M, Tamiya N, et al. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Crit Care. 2018;22(1):1–16. doi: 10.1186/s13054-018-2126-6. - DOI - PMC - PubMed
    1. Barry B. The role of tracheostomy in ICU. Anaesthesia & Intensive Care Medicine. 2004;5(11):375–378. doi: 10.1383/anes.5.11.375.53408. - DOI
    1. Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125(1):e104–e118. doi: 10.1016/j.bja.2020.04.054. - DOI - PubMed
    1. Kawale MA, Keche PN, Gawarle SH, Bhat SV, Buche A. A prospective study of complications of tracheostomy and management in tertiary care hospital in rural area. J Otolaryngology Head Neck Surg. 2017;5(3):687–92.