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Vargas M, Battaglini D, Antonelli M, Corso R, Frova G, Merli G, Petrini F, Ranieri MV, Sorbello M, Di Giacinto I, Terragni P, Brunetti I, Servillo G, Pelosi P. Follow-up short and long-term mortalities of tracheostomized critically ill patients in an Italian multi-center observational study. Sci Rep 2024; 14:2319. [PMID: 38281994 PMCID: PMC10822864 DOI: 10.1038/s41598-024-52785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
The effects of tracheostomy on outcome as well as on intra or post-operative complications is yet to be defined. Admission of patients with tracheostomy to rehabilitation facility is at higher risk of suboptimal care and increased mortality. The aim of the study was to investigate ICU mortality, clinical outcome and quality of life up to 12 months after ICU discharge in tracheostomized critically ill patients. This is a prospective, multi-center, cohort study endorsed by Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care (SIAARTI Prot. n° 643/13) registered in Clinicaltrial.gov (NCT01899352). Patients admitted to intensive care unit (ICU) and requiring elective tracheostomy according to physician in charge decision were included in the study. The primary outcome was ICU mortality. Secondary outcomes included risk factors for ICU mortality, prevalence of mortality at follow-up, rate of discharge from the hospital and rehabilitation, quality of life, performance status, and management of tracheostomy cannula at 3-, 6, 12-months from the day of tracheostomy. 694 critically ill patients who were tracheostomized in the ICU were included. ICU mortality was 15.8%. Age, SOFA score at the day of the tracheostomy, and days of endotracheal intubation before tracheostomy were risk factors for ICU mortality. The regression tree analysis showed that SOFA score at the day of tracheostomy and age had a preeminent role for the choice to perform the tracheostomy. Of the 694 ICU patients with tracheostomy, 469 completed the 12-months follow-up. Mortality was 33.51% at 3-months, 45.30% at 6-months, and 55.86% at 12-months. Patients with tracheostomy were less likely discharged at home but at hospital facilities or rehabilitative structures; and quality of life of patients with tracheostomy was severely compromised at 3-6 and 12 months when compared with patients without tracheostomy. In patients admitted to ICU, tracheostomy is associated with high mortality, difficult rehabilitation, and decreased quality of life. The choice to perform a tracheostomy should be carefully weighed on family burden and health-related quality of life.Clinical trial registration: Clinicaltrial.gov (NCT01899352).
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 80100, Naples, Italy.
| | | | - Massimo Antonelli
- Dip Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ruggero Corso
- Dipartimento delle Terapie Intensive, Anestesiologia e Terapia del Dolore, Ospedale "Guglielmo da Saliceto"-Piacenza, Piacenza, Italy
| | - Giulio Frova
- Università degli Studi di Milano and Dipartimento Anestesia e Rianimazione Spedai Civili si Brescia, Brescia, Italy
| | - Guido Merli
- U.O.C. Anestesia e Rianimazione Ospedale Maggiore di Crema, Asst Crema, Italy
| | - Flavia Petrini
- Coordinamento Strutturale Medicina Perioperatoria, Terapia Dolore, Emergenze Intraospedaliere, Terapia Intensiva - ASL2 Abruzzo, Università di Chieti-Pescara, Pescara, Italy
| | - Marco V Ranieri
- Alma Mater Studiorum-Università di Bologna, IRCCS Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | | | - Ida Di Giacinto
- Anesthesia and Intensive Care, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Pierpaolo Terragni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Iole Brunetti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 80100, Naples, Italy
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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Liu Y, He Q, Dou Z, Ma K, Chen W, Li S. Management Strategies for Congenital Heart Disease Comorbid with Airway Anomalies in Children. J Pediatr 2024; 264:113741. [PMID: 37726085 DOI: 10.1016/j.jpeds.2023.113741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To assess management strategies for pediatric patients with the challenging combination of congenital heart diseases (CHDs) and airway anomalies. STUDY DESIGN Patients diagnosed with CHD and airway anomalies in the Pediatric Cardiac Surgery Centre of Fuwai Hospital from January 2016 to December 2020 were included in this retrospective study. Patients were divided into three groups based on different management, including the conservative group, the slide group (slide tracheoplasty), and the suspension group (suspension with external stenting). Patients' data and computed tomography measurements from medical records were reviewed. RESULTS A total of 139 patients were included in the cohort; 107 had conservative airway treatment (conservative group), 15 had slide tracheoplasty (slide group), and 17 had tracheal suspension operation (suspension group). The top three associated intracardiac anomalies were ventricular septal defect (n = 34, 24%), pulmonary artery sling (n = 22, 16%), and tetralogy of Fallot (n = 15, 11%). Compared with patients with conservative airway management (100 minutes [median], 62-152 [IQR]), the extra airway procedure prolonged cardiopulmonary bypass duration, with 202 minutes (IQR, 119-220) for the slide group and 150 minutes (IQR, 125-161) for the suspension group. Patients who underwent slide tracheoplasty required prolonged mechanical ventilation (129 minutes [median], 56-328 [IQR]). Of the total cohort, 6 in-hospital deaths, all in the conservative group, and 8 mid-to long-term deaths, with 6 in the conservative group, occurred. CONCLUSIONS Both conservative and surgical management of CHD patients with airway anomalies have promising outcomes. Extra tracheobronchial procedures, especially the slide tracheoplasty, significantly prolonged cardiopulmonary bypass duration. Based on multidisciplinary team assessment, individualized management strategies should be developed for these patients.
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Affiliation(s)
- Yuze Liu
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Qiyu He
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Dou
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kai Ma
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weinan Chen
- Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Skrzypiec Ł, Rot P, Fus M, Witkowska A, Możański M, Jurkiewicz D. Early or late tracheotomy in patients after multiple organ trauma. Otolaryngol Pol 2021; 75:23-27. [PMID: 35175216 DOI: 10.5604/01.3001.0015.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The analysis of the study group of 124 patients revealed a statistically significant shortening of mechanical ventilation requirement period in patients in whom tracheotomy had been performed before hospitalization day 10 (G1). The average length of mechanical ventilation was shorter by 20.3 days in G1 as compared to G2. On average, the duration of ICU stay was shorter by 39.4 days in G1 as compared to G2. Total hospitalization time was also significantly shorter in this group of patients (G1). The overall length of hospital stay for patients in whom tracheotomy had been performed prior to hospitalization day 10 was on average 43.1 days shorter as compared to patients in whom the procedure had been performed at a later date. Tab. I. provides the comparison of the results obtained in both study groups. Statistically significant differences (p < 0.05) were demonstrated between G1 and G2 regarding the length of the mechanical ventilation, the length of ICU stay, and length of hospitalization. null null No statistically significant differences were observed in mortality rates between the study groups (Fig. 1.) (P = 0.256). The mortality rate in early tracheotomy group (G1) was lower and amounted to 2%. In patients in whom tracheotomy was performed on day 10 or later (G2), the mortality rate was slightly higher and amounted to 9%. In some patients, initiation of treatment was required due to pneumonia developing as a complication in mechanically ventilated patients and referred to as ventilator-associated pneumonia. This complication developed in 6 patients in G1 and 26 patients in G2. The study assessed the relationship between the occurrence of this complication and the timing of tracheotomy. Pneumonia was significantly more frequent in patients in whom tracheotomy had been performed on hospitalization day 10 or later (P = 0.011). null null The comparison of results is presented in Tab. II.</br> </br>Another analyzed aspect of the study consisted in the results obtained by the patients in the baseline evaluation of the level of consciousness as assessed using the Glasgow Coma Scale (GCS). Data were checked for potential correlation between the GCS scores and the timing of the tracheotomy and the lengths of mechanical ventilation, ICU stay, and hospitalization. Correlation between GCS scores and the duration of stay within the ICU was demonstrated with a statistically significant correlation coefficient (Spearman's rank coefficient in the range of -0.4 to -0.2). </br> </br>ICU stay and total hospitalization lengths were shorter in patients with higher baseline GCS scores compared to patients with lower baseline GCS scores. The results are illustrated graphically (Fig. 2., 3.).
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Affiliation(s)
- Łukasz Skrzypiec
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Medical Institute, Warsaw, Poland
| | - Piotr Rot
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Medical Institute, Warsaw, Poland
| | - Maciej Fus
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Medical Institute, Warsaw, Poland
| | - Agnieszka Witkowska
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Medical Institute, Warsaw, Poland
| | - Marcin Możański
- Department of Anaesthesiology and Intensive Therapy, Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defense, Warsaw, Poland
| | - Dariusz Jurkiewicz
- Klinika Otolaryngologii i Onkologii Laryngologicznej, Wojskowy Instytut Medyczny w Warszawie
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