This action might not be possible to undo. Are you sure you want to continue?
Requirement in EBP
³AN ANALYSIS: TRAHEOSTOMY VS. MECHANICAL VENTILATOR´
Submitted by: BSN 4F1 DUMANDAN, WENDY V. MANUEL, HAZEL ANN
Submitted to: MRS. ALARILLA
CHAPTER 1 The Problem and Its Setting Introduction Tracheotomy is performed during the ventilation of patients who present with difficulty weaning. length of stay and mortality in a medical ICU. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube. The main purpose of our study was to assess if tracheotomy compared to prolonged intubation. The contribution of precocious tracheotomy in ICU (intensive care unit) patients is still debated in comparison with prolonged intubation. reduces the duration of ventilation. The neck is cleaned and draped. A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. unless the situation is critical. General anesthesia is used. local anesthesia is injected into the area to reduce the discomfort caused by the procedure. This tube is called a tracheostomy tube or trach tube. frequency of nosocomial pneumopathy (NP). In that case. A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). .
We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation. used primarily in situations where a prolonged need for airway support is anticipated. In a nasotracheal procedure. in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea.Tracheal intubation. is the placement of a flexible plastic or rubber tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. Other methods of intubation involve surgery and include the cricothyrotomy (used almost exclusively in emergency circumstances) and the tracheotomy. intensive care unit length of stay. The most widely used route is orotracheal. usually simply referred to as intubation. an endotracheal tube is passed through the nose and vocal apparatus into the trachea. including mechanical ventilation. Background of the Study Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking. and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice. and to prevent the possibility of asphyxiation or airway obstruction. surgical methods are also used in emergency situations when conventional endotracheal intubation is not possible. It is frequently performed in critically injured. . ill or anesthetized patients to facilitate ventilation of the lungs.
and length of time in intensive care. Rationale of the Study Significance of the Study To the respondents. to reduce laryngeal ulceration. duration of mechanical ventilation. enhance mobility and speech and it enables care of the patient outside the ICU. nutrition. To the Researchers To the Students Nursing Profession Faculty/Clinical instructors . Early tracheotomy in critically ill medical patients who undergo 14 days of ventilation may have significant benefits over delayed tracheotomy.Tracheotomy is frequently performed in the ICU. The optimal time to perform a tracheotomy remains controversial. It is recommended to: improve respiratory mechanics. patient comfort and clearance of secretion. These include reduction in mortality rate. frequency of pneumonia.
CHAPTER 2 Statement of the problem .
purulent bronchial secretions. after the first period of tracheal intubation. We measured duration of ventilation. and a new . n=30) (the tracheotomy was performed between the eighth day and the fifteenth day. NP is a ventilator associated pneumonia. Method and Step by step procedure on how the study was conducted: It was a retrospective and comparative study. Abdelhamid Hachimi. Design Method Design: Clinical trial. We divided them into 2 groups: Tracheotomy Group (TG. incidence of each technique and mortality in ICU. leukocytosis or leucopenia. length of stay in ICU.Chapter 3 Title: Tracheotomy versus prolonged intubation in medical intensive care unit patients Proponent: Boubaker Charra. and Intubation Group (IG. conducted during seven years (20012007) in the medical intensive care unit at Ibn Rochd University hospital. Abdellatif Benslama. We included patients who presented with neurological injuries or respiratory failure and required mechanical ventilation (MV) for more than three weeks. defined by fever (>38. n=30) (patients are intubated throughout the period of hospitalization until extubation or death). frequency of NP.3 °C). Tracheotomy was performed using a surgical technique in the ICU by a critical care physician with low pressure tracheotomy tube cuffs.
or persistent infiltrate on chest radiography after 48 hours stay in ICU. gravity score (SAPS II and APACHE II) (table 1) and diagnosis (figure 1). P < 0.31 days) than in IG (31. All data were analyzed with SPSS 11. and no difference in the incidence of sinusitis. Cerebral hemorrhage and chronic obstructive pulmonary disease were the predominant diagnoses.74. The two groups were similar in mean age (40 ± 9 vs. Statistically. We compared qualitative variables using Student's t test.05 was considered significant. 23 % respectively The mean length of stay for all patients in ICU was 32 ± 9.4).26 ± 9.1) and in the duration of stay in ICU (TG 30.2 vs. 34.6 days (23 . p = 0.63 ± 6. were recruited in our study.57). The parameters in each group were compared using Chi-2 test and Fischer's exact test when necessary for qualitative variables.05 days) (table 2). The mean time for MV patients was 29 days (22-50) and shorter in TG (27.96 ± 9. Tracheotomy was realized between the eighth day and the fifteenth day.47 vs. We noticed one case of minor bleeding after tracheotomy. No tracheal stenosis has been noted in the two groups. Nosocomial pneumopathy was precocious in the IG than TG (table 2). p = 0.2) between both groups. there was no difference in mortality in the ICU (TG 26. who required MV. IG 46. Results/outcome of the study Results: A total of 60 patients. sex-ratio (1. 1.03 ± 3. and confirmed by bronchalveolar lavage. .7 %.7 % vs.0 for Windows. 42 ± 11 years). The mean age was 41 ± 11 years.
randomized. delayed nosocomial pneumopathy without modifying its frequency and the mean duration of hospitalization or death.com/articles/original-articles/83-tracheotomy-versusprolonged-intubation-in-medical-intensive-care-unit-patients Title: Early Percutaneous Tracheotomy Versus Prolonged Intubationof Mechanically Ventilated Patients After Cardiac Surgery Proponent: Jean-Louis Trouillet. Charles-Edouard Luyt. MD. Alain Pavie. MD.signavitae. controlled. MD. Jean Chastre. PhD.Conclusion: It seems that tracheotomy in medical ICU patients leads to decreased duration of ventilation. Pascal Leprince. Reference: http://www. PhD. Alexandre Ouattara. MD. Ralouka Makri. . MD. Elisabeth Vaissier. and Alain Combes. Marguerite Guiguet.gov registration number: NCT00347321). single-center trial(ClinicalTrials. MD. PhD. PhD Design: Prospective. MD. MD. PhD. Ania Nieszkowska. MD. MD.
as well as frequencies of ventilatorassociated pneumonia and other severe infections. 26% vs. The durations of mechanical ventilation and hospitalization. or 90-day mortality rates.Secondary outcomes included 28-. 4. 28%. 60-.4 days [SD.4] vs. However. and long-term health-related quality of life (HRQoL) and psychosocial evaluations. and 30% vs. or 90-day mortality rates (16% vs. 22. respectively. Measurements: The primary end point was the number of ventilator-free days during the first 60 days after randomization. sedative. 21%. 30%. early percutaneous tracheotomy was associated with less intravenous sedation. Objective: To compare the outcomes of severely ill patients whorequire prolonged mechanical ventilation randomly assigned toearly percutaneous tracheotomy or prolonged intubation. less time of . Setting: Academic center.3 days [SD. comfort and ease of care. 60-.1 to 8. unscheduled extubations. Intervention: Immediate early percutaneous tracheotomy or prolonged intubation with tracheotomy 15 days after randomization. Results/outcome of the study Results: : There was no difference in ventilator-free days during the first 60 days after randomization between early percutaneous tracheotomy and prolonged intubation groups (mean. analgesic.1 days [95% CI. absolute difference. and hospitalization.7]. 28. and neuroleptic use. were also similar.respectively). ventilatorassociated pneumonia rate.durations of mechanical ventilation.Method and Step by step procedure on how the study was conducted: Background: Whether early percutaneous tracheotomy in patientswho require prolonged mechanical ventilation can shorten mechanical ventilation duration and lower mortality remains controversial. 23. intensive care unit stay. 2. Patients: 216 adults requiring mechanical ventilation 4 or more days after cardiac surgery. 30.3 days]) nor in 28-.
Reference: Primary Funding Source: French Ministry of Health. After a median follow-up of 873 days. better comfort and ease of care. Conclusion: Early tracheotomy provided no benefit in terms of mechanical ventilation and length of hospital stay. Limitation: The prolonged intubation group had more ventilatorfree days during days 1 to 60 than what was hypothesized (mean. and long-term HRQoL for patients who require prolonged mechanical ventilation after cardiac surgery. better comfort. the well-tolerated procedure was associated with less sedation. and earlier resumption of autonomy. or both.154:373-383. fewer unscheduled extubations. 17. between-group survival. less haloperidol use for agitation.0]). and earlier resumption of oral nutrition. 2011. delirium.org .0 days [SD. psychosocial evaluations.heavy sedation. www. 23.annals. However. and HRQoL were similar. Ann Intern Med. rates of mortality or infectious complications.
473 (5. and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice.916 patients analyzed. p<. Method and Step by step procedure on how the study was conducted: OBJECTIVE: Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking.6%) of 43.7%.0) days of ventilatory support.Title: Relationship between tracheostomy timing and duration of mechanical ventilation Proponent: Freeman BD.0-14.1 vs. Buchman TG DESIGN: Analysis of Project Impact. PATIENTS: Data from 43. SETTING: Medical school. We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation. a multi-institutional critical care administrative database. intensive care unit length of stay. 71. Borecki IB. Tracheostomypatients had a higher survival rate than nontracheostomy patients (78.0 (5.916 patients were reviewed.001) and underwent this procedure following a median (25th-75th percentile) of 9. Coopersmith CM. INTERVENTIONS: None. . Results/outcome of the study Results: MEASUREMENTS AND MAIN RESULTS: Tracheostomy was performed in 2.
Tel.001 for all). and hospital days.5% of all ventilator. intensive care unit. and 13. Washington University School of Medicine. tracheostomy patients accounted for 26. MO. Title: Tracheostomy in patients with long-term mechanical ventilation: A survey Proponent: Respiratory Intensive Care Unit. respectively.690). St. intensive care unit.341. and hospital characteristics (p<. fax: +39 091 666 3505. 2 90129 Palermo. Conclusion: Although practice varies substantially.Tracheostomy frequency and timing varied significantly comparing patient.0%. Lazzaro. Reference: Department of Surgery. USA. Louis. Although a minority. 21. ARNAS. .05 for all).: +39 091 666 3506. intensive care unit length of stay. Terapia Intensiva Respiratoria. Tracheostomy timing correlated significantly with duration of mechanical ventilation (r = . Via C. and hospital length of stay. intensive care unit (r = . Ospedale Civico. tracheostomy timing appears significantly associated with duration of mechanical ventilation. 22% of patients were supported via tracheostomy at any given time. p<.2%.610). and hospital length of stay (r = . At most. Italy Corresponding author. These findings emphasize the need for an adequately supported multiple-center trial to better define patient selection for tracheostomy and to test the hypothesis that timing of this procedure influences clinically important outcomes.
Italian Association of Hospital Pulmonologists (AIPO) Method and Step by step procedure on how the study was conducted: Background Tracheostomy is increasingly performed in intensive care units (ICU). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24. 2) clinical criteria and systems for performing decannulation.4%). Percutaneous tracheostomies were 65. 489 (68%) males). thoracic dysmorphism 28 (3.4%).2%). Results/outcome of the study Results: 22/32 RICUs replied. number non-decannulated/non-ventilated. types of tracheostomy. 427 tracheostomies were evaluated for decannulation: 96 . Raffaele Scala. and outcome of patients undergoing tracheostomy (number decannulated.. Antonio Corrado.2) years. with many patients transferred to respiratory ICU (RICU). On behalf of the Intensive Care Study Group.8%). number non-decannulated/ventilated. neuromuscular diseases 200 (27. Nicolino Ambrosino. Aim and Method We report results of a one-year survey evaluating: 1) clinical characteristics. Major complications after tracheostomy were 2%.8%). Salvatore Corrao. complications in patients admitted to Italian RICU in 2006.3 (±14. Indications/timing for closing tracheostomy are discussed. obstructive sleep apnea syndrome 16 (2. dead/lost patients).7%). surgical patients 77 (10. exacerbation of Chronic Obstructive Pulmonary Disease 222 (34. There were 846 admissions of 719 patients (Mean age 64.9%.
175 patients (41%) were discharged with home mechanical ventilation. laryngo-tracheoscopy. Chih-Hsin Lee. Kuo-Chin Kao and Jui-Ying Fu Method and Step by step procedure on how the study was conducted: Introduction .resmedjournal. underlying diseases and ability to swallow. effective cough. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube. use of tracheal button and down-sizing. The clinical criteria chosen for decannulation were: stability of respiratory conditions. There was no agreement on indications and systems for closing tracheostomy. Chou-Chin Lan1. 114 patients (26.5%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10%) died or lost.(22. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation.5%) were closed. Conclusion: There were few major complications of tracheostomy.com/article/S0954-6111(10)00010-7/abstract Title: Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients Proponent: Yao-Kuang Wu1 . Chun-Yao Huang. Ying-Huang Tsai . Reference: http://www.
case-match analysis was performed. 41 days) were significantly longer in tracheostomized patients (all P < 0.Mechanical ventilation of patients may be accomplished by either translaryngeal intubation or tracheostomy. no definitive consensus indicates that tracheostomy is superior. and the factors associated with positive outcomes in all patients were determined. except for the fact that a trend for in-hospital mortality was noted to be higher in the translaryngeal group (P = 0. Comparable studies have not been performed in a respiratory care center (RCC) setting.05). Results/outcome of the study Results: Duration of RCC (22 vs. No significant differences were found in weaning success between the groups (both were >55%) or in RCC mortality.P < 0. This analysis confirmed the whole cohort findings. Treatment and mortality outcomes were compared between tracheostomized and translaryngeal intubated patients. 64 days) and total mechanical ventilation days (53 vs. 14 days) and total hospital stay (82 vs. Methods This was a retrospective observational study of 985 tracheostomy and 227 translaryngeal intubated patients who received treatment in a 24-bed RCC between November 1999 and December 2005.05). 31%. The rate of in-hospital mortality was significantly higher in the translaryngeal group (45% vs. Although numerous intensive care unit (ICU) studies have compared various outcomes between the two techniques.08). Because of significant baseline between-group heterogeneity. Stepwise logistic regression revealed that patients with a lower .
our findings do suggest that tracheostomy may increase the likelihood of patient survival.com/content/14/2/R26 . However.median severity of disease (APACHE II score <18) who were properly nourished (albumin >2. Reference: http://ccforum. Focused care administered by experienced providers may be more important for facilitating weaning success than the ventilation method used.05) Conclusion: These findings suggest that the type of mechanical ventilation does not appear to be an important determinant of weaning success in an RCC setting. Patients who were tracheostomized were also significantly more likely to survive (P < 0.5 g/dl) or had normal metabolism (BUN <40 mg/dl) were more likely to be successfully weaned and survive (all P < 0.05).
Santolan. Pasig City Landline Number: 681-2132 Mobile Number: 09066133278 Email Address: wendydumandan@yahoo. 1991 City Address: # 375 Dumandan St. Dumandan Age: 20 years old Nationality: Filipino Date or Birth: November 04.Manila Year Graduated : 2008 at present Secondary Education Institution : Sto.CURRICULUM VITAE PERSONAL INFORMATION Name: Wendy V. Tomas de Villanueva Catholic School Year Graduated : 2008 Primary Education Institution : Sto. Tomas de Villanueva Catholic School Year Graduated : 2004 .com EDUCATIONAL BACKGROUND Tertiary Education Field of Study : Bachelor of Science in Nursing Institution : Centro Escolar University .
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.