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Master Thesis

Impact de la trachéotomie percutanée sur la durée de ventilation en neuroréanimation

Abstract : Background: tracheostomy in the intensive care unit is not consensual. Specifically, in the neuro intensive care unit, protecting upper airways is challenging every day, in regards to altered conscience state and deglutition troubles. Tracheostomy could improve ventilatory mechanics in these patients. Factors associated to mechanical ventilation duration are not well defined. Our hypothesis was that tracheostomy could reduce mechanical ventilation duration. Methods: it was a retrospective study at neuro intensive care unit of the university hospital of Bordeaux. Between may 2016 and April 2018, 316 patients receiving mechanical ventilation for at least 72 hours in our neuro intensive care unit were retrospectively included, among them 50 were tracheostomized. Data collection included demographic variables, gravity scores, mechanical ventilation duration, length of stay in the intensive care unit. Multivariable analysis has been realized to study mechanical ventilation duration associated factors. Results: median mechanical ventilation duration in tracheostomized patients was 24,9 days [16,2-30,0] whereas intubated patients have been ventilated 9,5 days [6,0 - 10,9]. On the day they arrived, tracheostomized patients experienced more organ failure in regards to intubated patients (median SOFA score 8,0 [6,0 - 9,0] and 6,0 [5,0 - 8,0], p value = 0,038). Multivariable analysis made the tracheostomy an independent factor augmenting mechanical ventilation duration. We found only one mild complication linked to percutaneous tracheostomy procedure. Conclusion: percutaneous tracheostomy in the neuro intensive care unit make mechanical ventilation duration last longer. Weaning from mechanical ventilation protocol in those patients should be assessed.
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Submitted on : Thursday, December 19, 2019 - 2:23:49 PM
Last modification on : Friday, October 23, 2020 - 4:34:50 PM
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Pierre Sioniac. Impact de la trachéotomie percutanée sur la durée de ventilation en neuroréanimation. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02419378⟩



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