Schmidt, Matthieu and Fisser, Christoph and Martucci, Gennaro and Abrams, Darryl and Frapard, Thomas and Popugaev, Konstantin and Arcadipane, Antonio and Bromberger, Bianca and Lino, Giovanni and Serra, Alexis and Rozencwajg, Sacha and Lubnow, Matthias and Petrikov, Sergey and Mueller, Thomas and Combes, Alain and Pham, Tai and Brodie, Daniel (2021) Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study. CRITICAL CARE, 25 (1): 238. ISSN 1364-8535, 1466-609X
Full text not available from this repository. (Request a copy)Abstract
Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 +/- 16 years, 76% male, SAPS II score 51 +/- 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48-72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the "after ECMO" group, whereas it was unchanged in the "during-ECMO" group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MECHANICALLY VENTILATED PATIENTS; LIFE-SUPPORT; TRACHEOTOMY; MORTALITY; PLACEMENT; LEVEL; CARE; ECMO; Acute respiratory distress syndrome; Mechanical ventilation; Tracheostomy; Bleeding; Outcome |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 26 Sep 2022 08:14 |
| Last Modified: | 26 Sep 2022 08:14 |
| URI: | https://pred.uni-regensburg.de/id/eprint/47943 |
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