Challenges and risk factors in emergency tracheostomy,Pondicherry,India
Journal Title: Stanley Medical Journal - Year 2016, Vol 3, Issue 4
Abstract
Aim: Tracheostomy is indicated frequently in the treatment of critically ill patients who require prolonged mechanical ventilation. It is a surgical procedure, but not always without complications. Therefore the present study is to analyse the impact, risk factors and complications associated with this procedure in a tertiary care hospital. Methods: We extracted data on all patients admitted over a year period (January 2013 to March2014) who underwent tracheostomy. The severity of illness were estimated using the Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score II, post-resuscitation Glasgow Coma Score (GCS) and Injury Severity Score (ISS). Multiple variables such as admission, operative, ventilatory, and outcome were analyzed retrospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were also assessed. Results: About 66 patients underwent bedside tracheostomies in intensive care units and wards by open surgical technique. They were all in ventilator. The mean duration of stay in ICU was 14 days and in the ward 21 days. The median age of patient was 35(±10). Male patients formed 59% of the study population . The commonest reason for admission was for poisoning (42%) and neurological causes (33%). Tracheostomy was done within 4-7 days of intubation in 82% and in 18% after 7 days. The main indication for the procedure was prolonged ventilation (84.8%) and tracheobronchial secretions (15.2%). Out of total ventilated patients 52 were on CMV (Continuous mandatory ventilation) mode (79%). There were intra-operative, complications in 59% of the patients. Early in 22 (56%) and 6 (9%)patients developed late complications. The median age group to develop complication was 45(±10) years (10%). About 44 (74%) patients were successfully weaned from ventilator. Twenty two (44%) patients were weaned from ventilator in first 3 days. There were total of 17 deaths in ICU and one death in the ward . Mortality was higher in age group more than 45 years total 66.7%. The risk factors significant for complication were male gender and neurological diseases Conclusions: Early tracheostomy shortens days on the ventilator and intensive care unit . There is a need to focus training of the multidisciplinary team in management of tracheotomy in an emergency situation to reduce the morbidity
Authors and Affiliations
Jagadeeswaran V. U. , Shanmuganathan R, Sivasankar K, Tony Fredrick, Yuvaraj Jayaraman, Joseph K David
Keywords
Related Articles
- EP ID EP217216
- DOI -
- Views 105
- Downloads 0
PHENYTOIN INDUCED TOXIC EPIDERMAL NECROLYSIS (TEN) IN AN ADULT
A 38 year old male patient was treated with paracetamol and phenytoin tablets for fever and convulsions. On the fourth day of treatment, he developed generalised erythema and blistering of skin. A provisional diagnosis o...
A STUDY ON KNOWLEDGE AND PRACTICE OF BREAST SELF EXAMINATION AMONG WOMEN BETWEEN 30 TO 60 YEARS ATTENDING A TERTIARY CARE HOSPITAL IN CHENNAI
Context: Breast cancer is the leading malignancy affecting women worldwide. In India, it is the second most common cancer. Breast cancer has a better survival rate if identified in the initial stages. Breast self examina...
Simple modification of pedicled omental patch for peptic ulcer perforation; a resident’s technique
Pedicled omental patch for peptic ulcer perforation is a commonly done procedure. The use of an apical stitch on the pedicled patch can help surgeons in training to effectively place the patch with minimal assistance wit...
A STUDY ON NUTRITIONAL STATUS OF SCHOOL CHILDREN IN RURAL, SEMI URBAN AND URBAN AREAS OF TAMIL NADU.
BACKGROUND: The health and nutritional status of children is an index of national investment in the development of its future manpower. Malnutrition affects the child’s physical and cognitive growth and increases the su...
TINETTI’S POMA VERSUS HORAK’S BES TEST: CORRELATION WITH OTHER TOOLS OF BALANCE ASSESSMENT IN GERIATRIC AGE GROUP – AN ANALYTICAL OBSERVATIONAL STUDY
Context: Elderly population is growing gradually and the risk of fall increases with advancing age. It is important to predict the fall risk in order to prevent its unfavorable effects on quality of life of any elderly....