A comparison of early versus late tracheostomy after intubation for critically ill patients on long-term ventilation.

ISRCTN ISRCTN01157856
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

Rudolf-Buchheim-Street 7
Giessen
35392
Germany

Email Markus.Weigand@chiru.med.uni-giessen.de

Study information

Study designSingle centre cross-departmental prospective randomised active controlled clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use contact details below to request a patient information sheet.
Scientific titleA 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 objectivesLong-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) studiedIntensive Care Units (ICUs); Percutaneous Dilatational Tracheostomy (PTD); ventilatory support
InterventionAfter 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 typeProcedure/Surgery
Primary outcome measure1. 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 measuresNone
Overall study start date02/01/2005
Completion date02/01/2007

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants100
Key inclusion criteria1. 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 criteria1. 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 enrolment02/01/2005
Date of final enrolment02/01/2007

Locations

Countries of recruitment

  • Germany

Study participating centre

Rudolf-Buchheim-Street 7
Giessen
35392
Germany

Sponsor information

University Hospital of Giessen (Germany)
Hospital/treatment centre

Department of Anaesthesiology and Intensive Care Medicine
Rudolf-Buchheim-Street 7
Giessen
35392
Germany

Email Andreas.Hecker@chiru.med.uni-giessen.de
ROR logo "ROR" 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
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan