Indications, timing, and techniques of tracheostomy in 152 French ICUs

Study objectives: To investigate the current practice of tracheostomy in French ICUs, focusing on the frequency, timing, indications, and techniques. Design: A retrospective study. Setting: A questionnaire was sent to all ICUs included in the national registry of the Société de Réanimation de Langue Française. Patients: All ICU patients receiving mechanical ventilation (MV) during the year preceding the survey (excluding noninvasive ventilation) were covered by the questionnaire. Intervention: None. Measurements and results: Of the 708 ICUs invited to participate, 152 (21.5%) answered the questionnaire. Overall, 35,322 patients (median, 212 patients per unit; interquartile range [IQR], 148 to 329 patients) had received MV, including one fourth of patients for > 7 days. A median of 7.2% of patients (IQR, 2.9 to 11.1%) had undergone a tracheostomy. The most frequently reported indications for tracheostomy were prolonged MV (95%, after a median of 20 days) and failure of extubation (48%). An indication for "early" tracheostomy (ie, < 3 weeks) was considered in 68% of the ICUs, after a median time of 7 days. Physicians thought that performing tracheostomy would facilitate weaning from MV and early oral nutrition, and would improve overall patient comfort. The main disadvantages listed were tracheal complications, the aggressiveness of the procedure, and the risk of infection. Surgical techniques largely remained preferred compared to percutaneous techniques. Conclusions: There is much heterogeneity in the reported practices of tracheostomy in French ICUs. Three fourths of physicians considered that a randomized study comparing prolonged translaryngeal intubation and early tracheostomy in patients expected to receive prolonged MV would be necessary to clarify those issues.