Tracheotomy is increasingly performed in critically ill patients requiring prolonged respiratory support, weaning and frequent broncho-pulmonary toilet.
To ascertain current practice of tracheotomy in critically ill patients a simple questionnaire was sent to intensive care units (ICUs) throughout the Netherlands. Questionnaires were sent to the lead clinicians of ICUs with > 5 beds.
From the number of units responding (n = 28, 43.1%), the majority (n = 17, 60.7%) practiced percutaneous tracheotomy as opposed to open surgical tracheotomy. In the majority of hospitals tracheotomy was performed by the intensivist (n = 19, 67.9%), followed by the surgeon (n = 15; 53.6%), and the ENT-physician (n = 9, 32.1%). Tracheotomies were mainly performed in the ICU (n = 20; 71.4%), than in the operation room, and more tracheotomies were performed by a team (i.e., for each tracheotomy procedure more than one physician was present, n = 22, 78.6%) than by a single physician (n = 2, 7.1%). In the majority of ICUs no antimicrobial prophylaxis was given before tracheotomy (n = 23; 82.1%). Reasons for tracheotomy were polyneuropathy (n = 13; 46.4%), prolonged mechanical ventilation (> 14 days) (n = 22; 78.6%), and low GCS (n = 18; 64.3%). Although it was the policy to perform the procedure as soon as possible after it was clear that the patient fulfilled criteria for tracheotomy, in more than half of the cases tracheotomy was performed not earlier than after one week. Reasons varied from no operating room available (n = 5; 17.9%) to uncertainty about indication (n = 8; 28.6%).
In the Netherlands, the majority of tracheotomies are performed by the intensivist in the ICU, by using the percutaneous technique, and without antimicrobial prophylaxis.
Our data suggest that guidelines must be developed for this frequently performed procedure.
Marcus Schultz, None.