RevBrasAnestesiol.2017;67(3):329---330
REVISTA
BRASILEIRA
DE
ANESTESIOLOGIA
PublicaçãoOficialdaSociedadeBrasileiradeAnestesiologiawww.sba.com.br
LETTERS
TO
THE
EDITOR
Timing
of
percutaneous
tracheotomies
in
intensive
care
unit
Momento
propício
para
traqueostomia
percutânea
em
unidade
de
terapia
intensiva
DearEditor,
We read with great interest the article of Duran et al.1
concerningtiming ofpercutaneous tracheotomies inadult intensive care unit.Wecongratulatethem onthe presen-tationofthearticle.However,wewouldliketoaddsome comments.
Tracheotomy is a common procedure for patients who requireprolongedventilation.Itmaybebeneficialby lower-ingairwayresistance,improvingoralhygiene,andimproving pulmonary toilet and airway security and may also be associated withless sedative administration, less timeof sedation,enhancedpatientcomfort,andfewerpulmonary infections.2
Weagreewithauthoraboutthatearlypercutaneous tra-cheotomies shorten mechanical ventilation time,ICU and hospital stay times and result in less damage to the air-ways.Studiesshowedtheefficiencyofearlytracheotomyon mechanicalventilationtime,ICUstaytimesandpreventing the airwaydamage in critically illpatients. However, the optimaltiming(earlyvs.late)ofthetracheotomyin criti-callyillpatientsrequiringprolongedMVremainsunclear.3
The National Association of Medical Directors of Res-piratory Care recommended that tracheotomy should replace endotracheal intubation in patients who still require mechanical ventilation 3 weeks after admis-sion; and noted that identification of the optimal time for a tracheotomy to be performed is one of the most important criteria when deciding to perform the procedure.4
Analyses of some study groups showed that the rates andtimingoftracheotomyvariedsignificantlyacrossICUs.5
Apreconceivedopinion ofefficacy (in theabsenceof any evidence to support an optimal time for a tracheotomy) hasbeenarguedforexplainingthisincompatibilitybetween thewidespreaduseoftracheotomyanditsincoherentand non-homogenousclinicaluse.6Thismaybeofparticular
clin-icalimportancebecausepatientsreceiving atracheotomy requirealarge amount ofcare resourcesafterthe proce-dure.
Weobservenoticeableheterogeneityinthisstudy.This heterogeneitycouldbe associatedbydifferent numberof patient and illness in two groups. We think that patient condition and severity of illness may affect tracheotomy timingandoutcomes.Thusgroups formedshouldbemore homogenous.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
References
1.DuranM,AbdullayevR,C¸ömlekc¸iM,etal.Comparisonofearly andlatepercutaneoustracheotomiesinadultintensivecareunit. RevBrasAnestesiol.2014;64:438---42.
2.TrouilletJ, Luyt C,GuiguetM, etal. Earlypercutaneous tra-cheotomyversusprolongedintubationofmechanicallyventilated patientsaftercardiacsurgery.AnnInternMed.2011;154:373---83. 3.WangF,Wu Y,BoL, etal. Thetimingoftracheotomyin crit-ically ill patients undergoing mechanical ventilation. Chest. 2011;140:1456---65.
4.Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomyforpreventionofpneumoniainmechanically ven-tilatedadultI.C.U.patients.JAMA.2010;303:1483---9.
5.NathensAB,RivaraFP,MackCD,etal.Variationsinratesof tra-cheostomy inthecritically ill trauma patient. CritCareMed. 2006;34:2919---24.
6.Heffner JE. The role of tracheotomy in weaning. Chest. 2001;120:477---81.
SukruTekindura,MemduhYetimb,∗
aGulhaneMilitaryMedicalAcademy(GMMA),
DepartmentofAnesthesiologyandReanimation,
Ankara,Turkey
bVanMilitaryHospital,Van,Turkey
∗Correspondingauthor.
E-mail:[email protected](M.Yetim).
Availableonline10February2016
http://dx.doi.org/10.1016/j.bjane.2015.02.009 0104-0014/
