Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study
Abstract Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after E...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-07-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-021-03649-8 |
| _version_ | 1818620495791128576 |
|---|---|
| author | Matthieu Schmidt Christoph Fisser Gennaro Martucci Darryl Abrams Thomas Frapard Konstantin Popugaev Antonio Arcadipane Bianca Bromberger Giovanni Lino Alexis Serra Sacha Rozencwajg Matthias Lubnow Sergey Petrikov Thomas Mueller Alain Combes Tài Pham Daniel Brodie for the International ECMO Network (ECMONet) |
| author_facet | Matthieu Schmidt Christoph Fisser Gennaro Martucci Darryl Abrams Thomas Frapard Konstantin Popugaev Antonio Arcadipane Bianca Bromberger Giovanni Lino Alexis Serra Sacha Rozencwajg Matthias Lubnow Sergey Petrikov Thomas Mueller Alain Combes Tài Pham Daniel Brodie for the International ECMO Network (ECMONet) |
| author_sort | Matthieu Schmidt |
| collection | DOAJ |
| description | Abstract Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO. |
| first_indexed | 2024-12-16T17:54:18Z |
| format | Article |
| id | doaj.art-8554f89bea5849f495e5cdbf1dc79523 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-16T17:54:18Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-8554f89bea5849f495e5cdbf1dc795232022-12-21T22:22:13ZengBMCCritical Care1364-85352021-07-0125111110.1186/s13054-021-03649-8Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective StudyMatthieu Schmidt0Christoph Fisser1Gennaro Martucci2Darryl Abrams3Thomas Frapard4Konstantin Popugaev5Antonio Arcadipane6Bianca Bromberger7Giovanni Lino8Alexis Serra9Sacha Rozencwajg10Matthias Lubnow11Sergey Petrikov12Thomas Mueller13Alain Combes14Tài Pham15Daniel Brodie16for the International ECMO Network (ECMONet)Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and NutritionDepartment of Internal Medicine II, University Hospital RegensburgIRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive CareDepartment of Medicine, Columbia University College of Physicians & SurgeonsAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care UnitSklifosovsky Research Institute of Emergency MedicineIRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive CareCenter for Acute Respiratory Failure, New York-Presbyterian HospitalIRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive CareCenter for Acute Respiratory Failure, New York-Presbyterian HospitalAssistance Publique–Hôpitaux de Paris, Pitié–Salpêtrière Hospital, Medical Intensive Care UnitDepartment of Internal Medicine II, University Hospital RegensburgSklifosovsky Research Institute of Emergency MedicineDepartment of Internal Medicine II, University Hospital RegensburgSorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and NutritionUniversité Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche Clinique CARMASDepartment of Medicine, Columbia University College of Physicians & SurgeonsAbstract Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.https://doi.org/10.1186/s13054-021-03649-8ECMOAcute respiratory distress syndromeMechanical ventilationTracheostomyBleedingOutcome |
| spellingShingle | Matthieu Schmidt Christoph Fisser Gennaro Martucci Darryl Abrams Thomas Frapard Konstantin Popugaev Antonio Arcadipane Bianca Bromberger Giovanni Lino Alexis Serra Sacha Rozencwajg Matthias Lubnow Sergey Petrikov Thomas Mueller Alain Combes Tài Pham Daniel Brodie for the International ECMO Network (ECMONet) Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study Critical Care ECMO Acute respiratory distress syndrome Mechanical ventilation Tracheostomy Bleeding Outcome |
| title | Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study |
| title_full | Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study |
| title_fullStr | Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study |
| title_full_unstemmed | Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study |
| title_short | Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study |
| title_sort | tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation an international multicenter retrospective study |
| topic | ECMO Acute respiratory distress syndrome Mechanical ventilation Tracheostomy Bleeding Outcome |
| url | https://doi.org/10.1186/s13054-021-03649-8 |
| work_keys_str_mv | AT matthieuschmidt tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT christophfisser tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT gennaromartucci tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT darrylabrams tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT thomasfrapard tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT konstantinpopugaev tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT antonioarcadipane tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT biancabromberger tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT giovannilino tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT alexisserra tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT sacharozencwajg tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT matthiaslubnow tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT sergeypetrikov tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT thomasmueller tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT alaincombes tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT taipham tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT danielbrodie tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy AT fortheinternationalecmonetworkecmonet tracheostomymanagementinpatientswithsevereacuterespiratorydistresssyndromereceivingextracorporealmembraneoxygenationaninternationalmulticenterretrospectivestudy |