Patricia Anne Kritek, MD, EdM reviewing Young D et al. JAMA 2013 May 22. Angus DC. JAMA 2013 May 22.
Early tracheostomy did not limit mortality and resulted in many unneeded procedures.
Early tracheostomy for prolonged mechanical ventilation might be a way to liberate patients earlier from ventilators and shorten intensive care unit length of stay. Meta-analyses of small studies have had mixed results, and practices vary dramatically. To assess the effect on mortality of early versus late tracheostomy, U.K. investigators randomized 909 patients in 72 critical care units to tracheostomy either within 4 days of admission to critical care (early trach) or after 9 days if it was still indicated (late trach). Patients were enrolled in the study if treating physicians deemed them likely to require at least 7 days of mechanical ventilation.
In the early-trach group, 85% of patients underwent tracheostomy within 4 days, and 8% underwent the procedure later. Only 45% of patients in the late-trach group underwent tracheostomy, with 7% receiving off-protocol “early trach.” Mortality at 30 days, 1 year, and 2 years did not differ between the two groups, nor did hospital or critical care unit length of stay. In both groups, procedure-related complications (most commonly bleeding) occurred in roughly 6% of patients who received tracheostomies.
COMMENT
We are not good at predicting which patients are going to require prolonged mechanical ventilation: About one third of patients in the late-trach group were liberated from ventilators without undergoing tracheostomy. Additionally, we have no good clinical prediction rules for this decision. In light of this and the results of this study, the practice of routine early tracheostomy should end, because it results in many unneeded procedures without conferring any clear benefit.
CITATION(S):
- Young D et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 2013 May 22; 309:2121. (http://dx.doi.org/10.1001/jama.2013.5154)
- See more at: http://www.jwatch.org/na31158/2013/07/23/no-benefit-early-trach-prolonged-mechanical-ventilation?query=etoc_jwgenmed#sthash.M5Bv76Gf.dpuf
Huh? I learned one more abbrev 'trach' (for tracheostomy : noun a surgical operation that creates an opening into the trachea with a tube inserted to provide a passage for air; performed when the pharynx is obstructed by edema or cancer or other causes) but did not get what the rest is about.
Perhaps, if you care to explain how a decision to do a trach is made and for what, we may be able to see what we are talking about here. ;-)
BTW, how do we say 'trach'? 'track' or 'trash'?
I think you can say "track" for "trach".
I did not know well about this paper whether talking about trach in the particular situation. As you could see they just shown the association between time remained to die and types of trach. Anyway, trach is totally one of the unnatural medical manuver that could create patients and family suffering memory.
มามอบดอกไม้แต่ไร้ความเห็น เพราะเป็นภาษาที่ไม่เข้าใจ