The Intensive Care Medicine Department of Vall d’Hebron University Hospital and the Shock, Organ Dysfunction and Resuscitation (SODIR) research group at Vall d’Hebron Institute of Research (VHIR) have participated in a multicenter study that has established a new protocol that allows reducing the time to remove mechanical ventilation in patients with tracheostomy. The study has been led by Complejo Hospitalario Universitario de Toledo and has been published in the New England Journal of Medicine.
Dr. Gonzalo Hernández Martínez, from the Intensive Care Medicine at Hospital de Toledo, has led the study, where Vall d’Hebron University Hospital has participated, as well as Hospital Universitario Ramón y Cajal in Madrid, Hospital General Universitario in Ciudad Real and Hospital Universitario del Mar in Barcelona. From Vall d’Hebron, Dr. Oriol Roca and Dr. Marina Garcia-de-Acilu, from the Intensive Care Medicine Department in the hospital and researchers at the SODIR research group at VHIR have participated.
The study, carried out in 330 patients, shows that the application of a new protocol in patients admitted to the ICU, in whom a tracheostomy has been necessary due to the difficulty in removing artificial ventilation, shortens the time in which it can be removed, thus reducing hospital admission.
“With this criteria, we can remove the tracheostomy earlier. This considerably reduces the risk of complications, such as infections, in addition to shortening the patient’s stay in hospital”, emphasizes Dr. Oriol Roca. Likewise, shortening the time in which these patients need artificial ventilator support improves their quality of life, restarting their food intake or the capacity for oral communication.
This work is the final step in a research line that has generated various publications in international medical journals, culminating in the demonstration of the benefits of the new global protocol for the management of these complex patients at various points in their evolution.
For Dr. Gonzalo Hernández from Hospital de Toledo, “the real importance of these results is evidenced by the impact that these patients have, not only personally but also from an organizational point of view of the health systems”.
From a personal point of view, patients see accelerated recovery of such basic functions as communication with family members and improvement in coughing and swallowing. “There is an increase in comfort by removing invasive probes and annoying aspirations of respiratory secretions more quickly”, says Dr. Hernández.
Regarding health management, the repercussion of the results is high, since around 10-15% of all patients who require mechanical ventilation ultimately require a tracheostomy, which, by shortening the stay by more than one week affects the cost of managing these patients.
Tracheostomies are an alternative to conventional intubation necessary to be able to apply mechanical ventilation in such prolonged cases. Due to their characteristics, they are much more comfortable for patients and also for professionals when it comes to accelerating the withdrawal of mechanical ventilation.