Bench-to-bedside Review: Early Tracheostomy in Critically Ill Trauma Patients

Overview

Journal Crit Care

Specialty Critical Care

Date 2005 Dec 17

PMID 16356202

Citations 17

Authors

Nehad Shirawi

Yaseen Arabi

Affiliations

Soon will be listed here.

Abstract

A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy.

Citing Articles

Safety and Outcomes of Percutaneous Dilatational Tracheostomy in Patients with Hematologic Malignancies: A Retrospective Cohort Study.

Miller A, Noy R, Simchon O, Gvozdev N, Shkedy Y, Epstein D J Clin Med. 2025; 14(2).

PMID: 39860662 PMC: 11765863. DOI: 10.3390/jcm14020657.

The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital.

Zhao J, Zheng W, Xuan N, Zhou Q, Wu W, Cui W BMC Anesthesiol. 2024; 24(1):39.

PMID: 38262946 PMC: 10804499. DOI: 10.1186/s12871-024-02411-1.

[Focus on neurological intensive care medicine 2022/2023 : Summary of selected intensive medical care studies].

Michalski D, Jungk C, Beynon C, Brenner T, Nusshag C, Reuss C Anaesthesiologie. 2023; 72(12):894-906.

PMID: 37857724 DOI: 10.1007/s00101-023-01352-7.

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study.

Mulima G, Lie S, Charles A, Hanif A, Varela C, Banza L Malawi Med J. 2022; 34(3):152-156.

PMID: 36406102 PMC: 9641605. DOI: 10.4314/mmj.v34i3.2.

Early versus late tracheotomy in ICU patients: A meta-analysis of randomized controlled trials.

Deng H, Fang Q, Chen K, Zhang X Medicine (Baltimore). 2021; 100(3):e24329.

PMID: 33546065 PMC: 7837817. DOI: 10.1097/MD.0000000000024329.

References

Tejada Artigas A, Bello Dronda S, Chacon Valles E, Munoz Marco J, Villuendas Uson M, Figueras P . Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med. 2001; 29(2):304-9. DOI: 10.1097/00003246-200102000-00015. View

Mayberry J, Wu I, GOLDMAN R, Chesnut R . Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients. Crit Care Med. 2000; 28(10):3436-40. DOI: 10.1097/00003246-200010000-00011. View

Koh W, Lew T, Chin N, Wong M . Tracheostomy in a neuro-intensive care setting: indications and timing. Anaesth Intensive Care. 1997; 25(4):365-8. DOI: 10.1177/0310057X9702500407. View

Sims C, Berger D . Airway risk in hospitalized trauma patients with cervical injuries requiring halo fixation. Ann Surg. 2002; 235(2):280-4. PMC: 1422425. DOI: 10.1097/00000658-200202000-00017. View

Ikram M, Naviwala S . Case report: acute management of external laryngeal trauma. Ear Nose Throat J. 2000; 79(10):802-4. View

Plummer A, GRACEY D . Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989; 96(1):178-80. DOI: 10.1378/chest.96.1.178. View

Wolf M, Yellin A, Talmi Y, Segal E, Faibel M, Kronenberg J . Acquired tracheoesophageal fistula in critically ill patients. Ann Otol Rhinol Laryngol. 2000; 109(8 Pt 1):731-5. DOI: 10.1177/000348940010900806. View

Georges H, Leroy O, Guery B, Alfandari S, Beaucaire G . Predisposing factors for nosocomial pneumonia in patients receiving mechanical ventilation and requiring tracheotomy. Chest. 2000; 118(3):767-74. DOI: 10.1378/chest.118.3.767. View

Griffiths J, Barber V, Morgan L, Young J . Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005; 330(7502):1243. PMC: 558092. DOI: 10.1136/bmj.38467.485671.E0. View

10.

Kelly J, Webb W, Moulder P, Everson C, BURCH B, LINDSEY E . Management of airway trauma. I: Tracheobronchial injuries. Ann Thorac Surg. 1985; 40(6):551-5. DOI: 10.1016/s0003-4975(10)60347-5. View

11.

Kollef M, Von Harz B, Prentice D, Shapiro S, Silver P, St John R . Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest. 1997; 112(3):765-73. DOI: 10.1378/chest.112.3.765. View

12.

Bouderka M, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A . Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004; 57(2):251-4. DOI: 10.1097/01.ta.0000087646.68382.9a. View

13.

Thompson J, Gibson B, Kohut R . Airway obstruction in LeFort fractures. Laryngoscope. 1987; 97(3 Pt 1):275-9. View

14.

Johnston C, Rubenfeld G, Hudson L . Effect of age on the development of ARDS in trauma patients. Chest. 2003; 124(2):653-9. DOI: 10.1378/chest.124.2.653. View

15.

Nieszkowska A, Combes A, Luyt C, Ksibi H, Trouillet J, Gibert C . Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005; 33(11):2527-33. DOI: 10.1097/01.ccm.0000186898.58709.aa. View

16.

Arabi Y, Haddad S, Shirawi N, Al Shimemeri A . Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. 2004; 8(5):R347-52. PMC: 1065024. DOI: 10.1186/cc2924. View

17.

Stocchetti N, Parma A, Songa V, Colombo A, Lamperti M, Tognini L . Early translaryngeal tracheostomy in patients with severe brain damage. Intensive Care Med. 2000; 26(8):1101-7. DOI: 10.1007/s001340051324. View

18.

Ben-Nun A, Altman E, Best L . Emergency percutaneous tracheostomy in trauma patients: an early experience. Ann Thorac Surg. 2004; 77(3):1045-7. DOI: 10.1016/j.athoracsur.2003.09.065. View

19.

Holley H, Gildea J . Vocal cord paralysis after tracheal intubation. JAMA. 1971; 215(2):281-4. View

20.

Freeman B, Isabella K, Lin N, Buchman T . A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000; 118(5):1412-8. DOI: 10.1378/chest.118.5.1412. View