Tracheotomy timing according to APACHE II Score

Purpose: Tracheotomy represents an established procedure for airway management in critically ill patients who require long-term respiratory support. It offers advantages when compared to conventional translaryngeal intubation, but it is also associated with a number of serious complications. Several studies have been published to determine the best timing for tracheotomy with conflicting results. In this study we aimed to determine tracheotomy timing according to APACHE II scores of the ICU patients.Method and material: We studied 90 adult mixed ICU patients with respiratory failure. The tracheotomy requirement of the patients was determined as individual basis according to first day APACHE II scores. The elective postoperative patients or patients with requirement of short term mechanical ventilation were excluded from the study. Also contraindications of the percutaneous Griggs procedure were accepted as exclusion criteria. After initial stabilization and evaluation of the patients as percutaneous tracheotomy candidates, they were randomized to three groups. For group I (n=30, APACHE II score < 25, tracheotomy at 8-14. days); for group II (n=30, APACHE II score ? 25, tracheotomy at 1-7. days); for group III (n=30, APACHE II score ? 25, tracheotomy at 8-14. days). Procedure day APACHE II scores, ICU and hospital length of stay, length of time translaryngeal intubation, mechanical ventilation and 28 day mortality were recorded.Findings: The main demographics and clinical conditions of the patients were similar in our patients. We divided our patients in to three groups according to first day APACHE II scores. There were statistically significant difference in 28 day mortality, entubation time and hospital LOS in three groups (p < 0,05). There were statistically significant difference in the first day and procedure day APACHE II scores in group II and III (p < 0,05). The early tracheotomy group II had higher mortality rates and shorter hospital LOS. The procedure times and attempts were no different in three groups.Results: 28 day mortality of the ICU patients with respiratory failure which underwent early tracheotomy procedure according to first day APACHE II scores was higher than other groups. The statistically significant difference in the first day and procedure day APACHE II scores in group II and III might be demonstrate our ICU therapy effectiveness in relatively severe patients. There is no strict tracheotomy timing criteria for ICU patients with respiratory failure. When we evaluated our procedure times and attempts; we concluded that Griggs method of percutaneous tracheotomy was an easy, practical and suitable at the bed site.