Respiratory Failure, Tracheostomy Complication
Conditions
Brief summary
The optimal timing of tracheostomy insertion remains uncertain. We hypothesized that a clinical pathway including expert-informed risk assessment regarding predicted duration of mechanical (MV) would enhance the effectiveness of early percutaneous dilatational tracheostomy (PDT) for patients with anticipated prolonged durations of MV, as reflected by duration of ventilation, complications, and patient-centered outcomes.
Detailed description
three-year prospective observational study (2018-2020) at a tertiary care level 1 trauma center (King Hussein Medical Center) in Amman Jordan and 4 affiliated subspecialty hospitals. The study sequentially enrolled all adult patients (\>18yo) with critical illness receiving MV in an intensive care unit for 48 hours or longer. Institutional ethical committee clearance for the study was secured.
Interventions
OTHERExpert-Guided Early Tracheostomy
Patients judged to be at moderate to high risk of prolonged ventilation(26, 27) were those who had chronic respiratory failure, advanced Effectiveness of an Expert-Guided Early Tracheostomy Pathway Page 6/27 age, thrombocytopenia or coagulopathy, persistent vasopressor shock, requirement for renal replacement therapy, an admission trauma diagnosis amongst other criteria, were included. In the absence of these criteria, a consensus for low risk of prolonged MV was reached. Early PDT, within the first 7 days from intubation, was recommended for patients with a moderate/high risk of prolonged MV (Early Group). Continued MV by ETT was recommend for low-risk patients with the potential for delayed PDT in the event of delayed weaning and liberation (Late Group).
Sponsors
Denver Health Medical Center
Denver Health and Hospital Authority
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing continued MV for 48 or more hours for whom continuation of life-prolonging therapy was indicated
Exclusion criteria
Patients at imminent risk of death were included
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of hospitalization from admission to ventilator independent discharge | Hospital stay up to 90 days | Length of stay in days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Easy or Moderately Easy to Wean | Hospital stay up to 90 days | Numeric Score |
| Days of ventilation requiring administration of NMB | Hospital stay up to 90 days | Fraction of days when patient are mechanically ventilated and received NMB |
| Difference in average and total morphine equivalent dose | Hospital stay up to 90 days | Derived dose of morphine equivelants based on potency in mg |
| 90 day survival | 90 days | Survival recorded through 90 days from admission |
Countries
Jordan
Outcome results
None listed