Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study
Open Access
- 7 July 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 25 (1), 1-11
- https://doi.org/10.1186/s13054-021-03649-8
Abstract
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. International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. 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. 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.Keywords
This publication has 24 references indexed in Scilit:
- ECMO for severe ARDS: systematic review and individual patient data meta-analysisIntensive Care Medicine, 2020
- Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation SupportASAIO Journal, 2019
- Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center ExperienceJournal of Intensive Care Medicine, 2019
- Control of Confounding and Reporting of Results in Causal Inference Studies. Guidance for Authors from Editors of Respiratory, Sleep, and Critical Care JournalsAnnals of the American Thoracic Society, 2019
- Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countriesCritical Care, 2018
- Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2018
- Early vs late tracheostomy in critically ill patients: a systematic review and meta‐analysisThe Clinical Respiratory Journal, 2015
- Early Percutaneous Tracheotomy Versus Prolonged Intubation of Mechanically Ventilated Patients After Cardiac SurgeryAnnals of Internal Medicine, 2011
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patientsJournal of Thrombosis and Haemostasis, 2009
- Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients*Critical Care Medicine, 2005