Die dilatative Tracheotomie auf der anästhesiologischen Intensivstation - retrospektive Analyse von Daten der Jahre 2003 bis 2006

Abstract

OBJECTIVES: Data of 248 patients who underwent percutaneous dilatational tracheostomy (PDT) from 2003 to 2006 were analysed retrospectively. Main interests were to determine how many and when patients were treated, what differences existed in demographical data, preexisting conditions and main illness between the early (< or = 7 days) and the late (> 7 days) tracheostomy group, also, to determine clinical outcome early vs. late and sedative and noradrenaline administration before vs. after PDT. METHODS: Data were derived from an internal and a clinic-wide database, patient charts and doctor´s letters. Parameters were defined and analysed. Where reasonable, statistical tests were performed. RESULTS: The percentage of ICU patients undergoing PDT rose from 9.9 % in 2003 to 12.8 % in 2006. Median time from ICU admission to PDT was 7 days. Patients admitted for general surgery were significantly more common in the late group (41 vs. 24 %), neurosurgical patients in the early group (28 vs. 12 %). The late group was significantly more severely diseased measured by SAPS II. Other data did not correlate with timing of PDT. ICU stay was significantly shorter for the early group (17 days vs. 29 days late, median), while mortality, complication rates, number of re-dilatations and number of patients discharged with or without tracheal cannula, did not significantly differ. Doses of propofol, midazolam, sufentanil and noradrenaline (norepinephrine) compared 3 days before PDT to 3 days after were significantly reduced. DISCUSSION: Patients profited by early PDT which was reflected in a shorter ICU stay. After PDT, medication could be significantly reduced. Therefore, a common effect of reduced sedation, catecholamine administration and accelerated weaning from MV could possibly explain the shorter ICU stay. Some parameters were distributed inhomogeneously, which is why further studies are needed to find predictors for who will profit more by early PDT and who will less.