Evoluation of the patients who performed tracheostomy in Akdeniz University anesthesia intensive care unit from 2010 to 2014

Tracheostomy is a favored alternative option for providing prolonged mechanical ventilation and safety airway used for more than 70 years. Despite its numerous advantages, tracheostomy may have severe complications as being an invasive method for presenting respiratory tract patency. Besides, the tracheostomized patients usually have prolonged ICU stay, high mortality and morbidity arise from concomitant comorbidities. The aim of the study was to evaluate the frequency, patient characteristics, complications and the prognosis related with our percutaneous dilatational tracheostomy (PDT) practice. Hospital electronic records and intensive care unit (ICU) files of the patients with percutaneous tracheostomies performed in our 34 bed anesthesiology ICUs were evaluated between January 2010 and December 2014. Demographic variables of the patients, ICU admission and tracheostomy indications, intubation history, method for tracheostomy procedure, ICU stay or tracheostomy duration, decannulation and /or recannulation status, early and late complications were recorded. There were 442 patients who underwent tracheostomy during their ICU stay in the study period. The most frequent pathologies of the patients were related with neurosurgery (36.9%), pulmonology (19.9%), neurology (11.3%) and general surgery (11.1%) disciplines. Tracheostomy procedures were performed surgically at operation room by surgeons in 29 patients and percutaneously at bed side by intensivists in 413 patients. Mean tracheostomy performance day after ICU admission was 9.9 days. Overall complication incidence was 7.0% (31 patients; 23 early and 8 late complications) while the major complication was bleeding at early period (2.9%). Mean age and mortality of the patients were 56 and 44.8% respectively. Among survivors; 61.6% patients were decannulated, 18.6% patients were discharged with home mechanical ventilator, 13% patients were discharged with tracheostomy cannula at spontaneous ventilation and 6.5% patients were discharged with small sized (4.5F) tracheostomy cannula left for pulmonary aspiration. The results of our study were in accordance with previous studies investigating tracheostomy timing and complication rates (Ref). End of life decisions are rarely implemented due to relatives opposition and legal uncertainty in our country. Majority of our tracheostomized patients suffered from intracranial pathologies with unavoidable mortality. For the reason, we were obligated to perform tracheostomy in these patients on the occasion of prolonged translaryngeal intubation which may lead to prolonged ICU stay and high mortality in our study.