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Tracheotomy in Patients Who Require Prolonged Mechanical Breathing Support FREE

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The full report is titled “Early Percutaneous Tracheotomy Versus Prolonged Intubation of Mechanically Ventilated Patients After Cardiac Surgery. A Randomized Trial.” It is in the 15 March 2011 issue of Annals of Internal Medicine (volume 154, pages 373-383). The authors are J.L. Trouillet, C.E. Luyt, M. Guiguet, A. Ouattara, E. Vaissier, R. Makri, A. Nieszkowska, P. Leprince, A. Pavie, J. Chastre, and A. Combes.

Ann Intern Med. 2011;154(6):I-38. doi:10.7326/0003-4819-154-6-201103150-00001
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What is the problem and what is known about it so far?

Patients who require the help of a breathing machine (mechanical ventilation) for more than a few weeks usually undergo a surgical procedure (tracheotomy) to support breathing through a small hole in the neck rather than through a tube inserted through the mouth or nose. Whether it is better to do a tracheotomy sooner rather than wait a few weeks is not known.

Why did the researchers do this particular study?

To see if doing a tracheotomy soon after heart surgery was beneficial when other treatment factors were kept the same.

Who was studied?

216 adults who still needed a breathing machine 4 days after heart surgery.

How was the study done?

Patients were randomly assigned to have an early tracheotomy done in the intensive care unit within 1 day or breathing support continued through a tube already inserted into the mouth for up to 2 weeks, at which time a tracheotomy was considered. The researchers evaluated how long each group remained on the breathing machine and whether there were benefits to 1 approach over the other.

What did the researchers find?

There was no difference between the groups in how long they remained in the intensive care unit or hospital or in how long they lived. There was also no difference seen in how much time the patients were able to remain off the breathing machine. In contrast, less medicine for anxiety or pain was required by the patients who had a tracheotomy done immediately, and these patients' nurses judged them as being more comfortable and easier to care for than the patients who remained initially with a breathing tube in the mouth. Several months later, the 2 groups of patients reported similar memories of their hospitalization and similar quality of life.

What were the limitations of the study?

The study may have been too small to see a difference between the groups, and it studied only patients who had undergone heart surgery. In addition, because it was not possible to prevent the physicians and nurses from knowing whether the patient had received a tracheotomy, other differences in how these patients were treated or evaluated might have affected the results.

What are the implications of the study?

More study is needed to determine whether some patients benefit from having a tracheotomy done sooner rather than later.





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