Tracheostomy – percutaneous dilatational or standard surgical? Are there any helpful prognostic aids?

Introduction:

Patients in need for longterm tracheal cannula benefit from a surgical tracheostomy. For choosing the tracheostomy procedure (percutaneous dilatational tracheostomy (PDT) or standard surgical (sT)) a prognostic aid about the perspective cannulation period would be helpful. The aim was to identify prognostic parameters.

Methods:

All patients who received a tracheostomy in the University hospital of Dresden during a 12 months period were included prospectively. The study period extended from the time of the tracheostomy until 12 months later. Clinical parameters were calculated into the used common scores (SAPS II, GCS, mRS, NIHSS) and individual period predictions until weaning and decannulation by nursing and medical staff evaluated.

Results:

340 patients received a tracheostomy in 9 clinical departments. In 39% (n = 129) a PDT and in 61%(n = 198) a sT was carried out. Especially patients with neurological deficits and oncologic diseases (n = 26 resp. n = 18) had still a cannula after 12 month. The time prediction until decannulation done by medical staff was a significant parameter. The SAPS II showed a significant correlation to perceive the weaning period. All other scores do not serve for prognostic indications.

Conclusions:

A close cooperation inbetween Head&Neck surgeons and intensive care specialists already at the time of indication for PDT and sT, that not only focuses on the individual conditions but also on the longterm perspective is desirable to avoid complications and gain a perfect care situation.

Publication History

Publication Date:
18 April 2018 (online)