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  • Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience

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    Accepted Manuscript (AM)
    Author(s)
    Grewal, J
    Sutt, AL
    Cornmell, G
    Shekar, K
    Fraser, J
    Griffith University Author(s)
    Fraser, John F.
    Year published
    2019
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    Abstract
    Purpose: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. Methods: Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and ...
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    Purpose: Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. Methods: Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. Results: Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose (P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference (P value = .46) in the amount of PRC used post-TT. Conclusions: These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.
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    Journal Title
    Journal of Intensive Care Medicine
    DOI
    https://doi.org/10.1177/0885066619837939
    Copyright Statement
    Grewal, J.; Sutt, A. L.; Cornmell, G.; Shekar, K.; Fraser, J., Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience, Journal of Intensive Care Medicine, 2019, pp. 1-9. Copyright 2019 The Authors. Reprinted by permission of SAGE Publications.
    Note
    This publication has been entered into Griffith Research Online as an Advanced Online Version.
    Subject
    Nursing
    Clinical Sciences
    Publication URI
    http://hdl.handle.net/10072/386657
    Collection
    • Journal articles

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