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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2013 Febbraio;79(2):156-64
Tracheostomy in Intensive Care Unit: a national survey in Italy
Vargas M. 1, 2, Servillo G. 2, Arditi E. 1, Brunetti I. 1, Pecunia L. 1, Salami D. 1, Putensen C. 3, Antonelli M. 4, Pelosi P. 1 ✉
1 Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino – IST, University of Genoa, Genoa, Italy;
2 Department of Anesthesia and Intensive Care Medicine, University of Naples “Federico II”, Naples, Italy;
3 Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany;
4 Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy
Background: The aim of the present study was to evaluate the frequency of different techniques, indications, timing, as well as procedural features, sedation and ventilation protocols, early and late complications of tracheostomy in Intensive Care Unit (ICU).
Methods: This was a retrospective survey on data collected in 2011. A questionnaire was mailed to all members of the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI).
Results: We included in the analysis 131 questionnaires. We found that: 1) Ciaglia Blue-Rhino® (CBR) was the most commonly used tracheostomy (32.8%; N.=1953) and the main indication was prolonged mechanical ventilation (58.8%; N.=77); 2) tracheostomy was performed between 7-15 days (71.8%; N.=94) from ICU admission by a dedicated team (62.6%; N.=82) involving more than one intensive care physician and a nurse; 3) tracheostomy was frequently guided by fiberoptic bronchoscope (93.1%, N.=122) while neck ultrasounds were used as a screening procedure to assess at-risk structure often in presence of pathological anatomical structures (68.7%; N.=90); 4) ventilation protocol and sedation-analgesia-neuromuscular blocking protocol were available in 83.2% and 58.8% of ICUs, respectively; 5) minor bleeding controlled by compression was the most common early and late complication.
Conclusion: Percutaneous tracheostomy is well established in Italian ICUs and CBR is the most popular technique performed in patients requiring prolonged mechanical ventilation. Tracheostomy is usually performed by a dedicated team using a specific sedation-analgesia-neuromuscular blocking and ventilation protocol, guided by fiberoptic bronchoscope and/or neck ultrasounds. Bleeding controlled by compression was the most common early and late complication.