TY - JOUR
T1 - Evidence-based guidelines for the use of tracheostomy in critically ill patients
AU - Raimondi, Néstor
AU - Vial, Macarena R.
AU - Calleja, José
AU - Quintero, Agamenón
AU - Cortés, Albán
AU - Celis, Edgar
AU - Pacheco, Clara
AU - Ugarte, Sebastián
AU - Añón, José M.
AU - Hernández, Gonzalo
AU - Vidal, Erick
AU - Chiappero, Guillermo
AU - Ríos, Fernando
AU - Castilleja, Fernando
AU - Matos, Alfredo
AU - Rodriguez, Enith
AU - Antoniazzi, Paulo
AU - Teles, José Mario
AU - Dueñas, Carmelo
AU - Sinclair, Jorge
AU - Martínez, Lorenzo
AU - von der Osten, Ingrid
AU - Vergara, José
AU - Jiménez, Edgar
AU - Arroyo, Max
AU - Rodríguez, Camilo
AU - Torres, Javier
AU - Fernandez-Bussy, Sebastián
AU - Nates, Joseph L.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objectives To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. Methods A taskforce 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 taskforce 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 6 questions. Conclusions Percutaneous techniques are associated with a lower risk of infections compared with 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.
AB - Objectives To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. Methods A taskforce 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 taskforce 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 6 questions. Conclusions Percutaneous techniques are associated with a lower risk of infections compared with 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.
KW - Clinical guidelines
KW - Consensus
KW - Critical care
KW - Intensive care unit
KW - Percutaneous
KW - Tracheostomy
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U2 - 10.1016/j.jcrc.2016.10.009
DO - 10.1016/j.jcrc.2016.10.009
M3 - Article
C2 - 28103536
AN - SCOPUS:85013650266
SN - 0883-9441
VL - 38
SP - 304
EP - 318
JO - Journal of critical care
JF - Journal of critical care
ER -