A comparison of early versus late tracheostomy after intubation for critically ill patients on long-term ventilation.
ISRCTN | ISRCTN01157856 |
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DOI | https://doi.org/10.1186/ISRCTN01157856 |
Secondary identifying numbers | N/A |
- Submission date
- 23/01/2010
- Registration date
- 19/02/2010
- Last edited
- 19/02/2010
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Surgery
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year
Plain English summary of protocol
Not provided at time of registration
Contact information
Prof Markus Weigand
Scientific
Scientific
Rudolf-Buchheim-Street 7
Giessen
35392
Germany
Markus.Weigand@chiru.med.uni-giessen.de |
Study information
Study design | Single centre cross-departmental prospective randomised active controlled clinical trial |
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Primary study design | Interventional |
Secondary study design | Randomised controlled trial |
Study setting(s) | Hospital |
Study type | Treatment |
Participant information sheet | Not available in web format, please use contact details below to request a patient information sheet. |
Scientific title | A prospective randomised trial to compare the effects early versus late Percutaneous Dilatational Tracheostomy (PTD) after incubation on the rate of Ventilator-Associated Pneumonia (VAP), mortality and other factors in critically ill patients on long-term ventilation. |
Study objectives | Long-term ventilation in intensive care units is associated with several problems such as increased mortality, increased rates of ventilator associated pneumonia (VAP), prolonged time of hospitalisation, and thus, leads to enormous financial consequences. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalisation has already been analyzed in several studies, the point of timing of the tracheostomy procedure on patient's mortality is still controversial. Within 2 years, 100 critically ill, mainly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy (PDT) was performed either early (4 days after intubation, 2.8 days median) or late (more than 6 days after intubation, 8.1 days median) after intubation. We compared both groups concerning outcome, VAP incidence and duration of hospitalisation and ventilation. This was a cross-departmental trial with collaboration between the Dept. of Anaethesiology, Dept. of Surgery Dept. of Neurosurgery and Dept. of Neurology. Hypotheses: 1. Early tracheostomy is associated with a decreased mortality in critically ill surgical patients. 2. Early PDT performance, in comparison with late tracheostomy, is associated with decreased rates of VAP, duration of ventilation and time of hospitalization both in hospital and in (Intensive Care Units (ICUs). |
Ethics approval(s) | Ethics approval was received by the Ethics board of the University Hospital of Giessen, Germany in January 2005. |
Health condition(s) or problem(s) studied | Intensive Care Units (ICUs); Percutaneous Dilatational Tracheostomy (PTD); ventilatory support |
Intervention | After intubation patients either entered the early (ET) or the late tracheostomy (LT) trunk of this study: In ET patients a percutaneous dilatational tracheostomy was performed within 4 days after intubation/trauma/surgery in LT patients the same procedure was performed after more than 6 days of intubation. The Acute Physiology And Chronic Health Evaluation II (APACHE II) score was used to define the severity of the trauma. In each group 25 patients with APACHE II < 25 and > 25 were recruited. Patients were followed until discharged from the hospital or rehabilitation centre. |
Intervention type | Procedure/Surgery |
Primary outcome measure | 1. VAP as defined by 1.1. Clinical Pulmonary Infection Score (CPIS) 1.2. Sequential Organ Failure Assessment (SOFA) score 2. APACHE II score 3. Simplified acute physiology score (SAPS) 4. Temperature 5. Laboratory values 5.1. C-Reactive Protein (CRP) 5.2. Leukocytes 6. Thoracic X-ray 7. Days in ICU/hospital 8. Hours of ventilatory support APACHE II score was measured at baseline, all other outcomes were measured daily. |
Secondary outcome measures | None |
Overall study start date | 02/01/2005 |
Completion date | 02/01/2007 |
Eligibility
Participant type(s) | Patient |
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Age group | Adult |
Lower age limit | 18 Years |
Sex | Both |
Target number of participants | 100 |
Key inclusion criteria | 1. Critically-ill patients requiring ventilatory support and intubation, recruited from the following three ICUs: surgical, neurological, neurosurgical. 2. Expected time of ventilation > 21 days 3. Age > 18 years 4. Informed consent that the patient may be included into the study |
Key exclusion criteria | 1. Anatomic variants or deformities of the larynx, trachea, and collum 2. Pre-existing tracheostomy 3. Pre-existing pneumonia 4. Critical trauma of the cervical vertebral column 5. Coagulopathy (thrombocytes < 60,000 per μl, prothrombin time > 40 seconds, international normalized ratio > 1.4) 6. Estimated to die within the next 24 h 7. Planned permanent tracheostomy (after laryngectomy) 8. More than 3 days of ventilation before entry into the study |
Date of first enrolment | 02/01/2005 |
Date of final enrolment | 02/01/2007 |
Locations
Countries of recruitment
- Germany
Study participating centre
Rudolf-Buchheim-Street 7
Giessen
35392
Germany
35392
Germany
Sponsor information
University Hospital of Giessen (Germany)
Hospital/treatment centre
Hospital/treatment centre
Department of Anaesthesiology and Intensive Care Medicine
Rudolf-Buchheim-Street 7
Giessen
35392
Germany
Andreas.Hecker@chiru.med.uni-giessen.de | |
https://ror.org/032nzv584 |
Funders
Funder type
Hospital/treatment centre
University Hospital of Giessen (Germany) - Department of Anaesthesiology and Intensive Care Medicine
No information available
Results and Publications
Intention to publish date | |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not provided at time of registration |
Publication and dissemination plan | Not provided at time of registration |
IPD sharing plan |