Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland

Abstract

Objective: To assess the frequency, timing and technique of tracheostomy and its variation between different intensive care units (ICUs) in Switzerland. Design: Retrospective, descriptive prevalence study. Setting: A questionnaire was sent to all intensive care units formally recognized by the Swiss Society of Intensive Care Medicine. Excluded were paediatric ICUs. A total of 48 ICUs (70%) responded. Patients: In 1995 and 1996 the participating units had admitted 90,412 patients for a total of 243,921 ICU days. Results: Seventy percent of the contacted ICUs answered the questionnaire. The prevalence of tracheostomy was 10% in the long-term ventilated patients (defined as >24 h), or 1.3% of all patients. Most tracheostomies were performed during the 2nd week of ventilation. The frequency of tracheostomy varied widely (0–60%) and was only slightly associated with the different language regions of our country and with the policy of hospitals to accept or refuse intubated patients on their normal wards. Most units offered either conventional surgical tracheostomy (69%) and/or percutaneous procedures (57%). The decision to perform a tracheostomy was made mostly by the intensivist and the procedure was more often performed in the ICU (65%) than in the operating theatre (35%). Units where the intensivist had exclusive control used only percutaneous techniques. An overall complication rate of 13% was reported, bleeding and infections being at the top of the scale. Only 27% of the units performed late follow-up protocols. Conclusions: Despite its frequency, tracheostomy in Swiss ICUs is far from being standardized with regard to indication, timing and choice of technique.