Trachs

[urge]

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How soon after a bad case are people getting trached at your hospital?

Early trach seems to be en vogue at my hospital.

 

[pgg]

Too soon, on the whole, IMO.


When I was a resident, my first intraop death was a trach done too soon. He could've kept his ETT another week while his various organ systems clawed their way off the edge of death, instead the early trach mantra won out and we pushed him off the edge completely.

Trachs are like any other non-urgent case and should be done when the patient is optimized. Just because the patient is stuck riding a vent and will need it long term doesn't mean there can't be real improvement to the rest of their organ systems.

In sick patients I think a lot of surgeons try to get them done too early.

 

[G-Man82]

At my hospital we usually trach around 2 weeks and after a failed extubation or two. It's not as bad here because we run a percutaneous bedside Tracheostomy service. We save Anesthesiology from OR trachs. Lol.

 

[bigdan]

There was a recent, well-done paper suggesting there was no benefit (to the patient) from early trach (within 4 days of ETT), as opposed to waiting (10 or more days after ETT). That said, placing a trach significantly increases Medicare reimbursement, so the surgeon and hospital benefit greatly. If you get the trach in early and the pt still dies, you get more days of more money.

http://www.ncbi.nlm.nih.gov/pubmed/23695482

 

[seinfeld]

For us it depends on the reason for prolonged ventilation. A COPD patient who has failed extubation 2 xs despite decent PSV trials will get one quickly.

For a complicated mulitorgan failure patient we will wait until the patient is in the 2-3 week range and all the major medical problems have stablized.

For a Dead head , i.e. anoxic encephalopathy patient its a week then trach & peg and then to the chronic vent floor