Kingdom; 2 University of Cambridge, Cambridge, United Kingdom

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1 P-111 TIMING OF TRACHEOSTOMY AND ASSOCIATED COMPLICATIONS IN CARDIOTHORACIC INTENSIVE CARE PATIENTS Zochios, Vasileios 1 ; Casey, Jessica 2 ; Vuylsteke, Alain 1 1 Cardiac Critical Care Unit, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom; 2 University of Cambridge, Cambridge, United Kingdom Introduction: Tracheostomy is an invasive procedure that creates a surgical airway in the cervical trachea and is commonly performed in critically ill patients requiring prolonged mechanical ventilation (MV). Tracheostomy is not without risks and prediction of which patients will require prolonged MV and decision about optimal timing (early vs late) of tracheostomy remain contentious in the medical literature. Objectives: To report tracheostomy-related complications and determine the association between timing of tracheostomy and duration of MV, in a tertiary care teaching hospital cardiothoracic intensive care unit (ICU). Methods: After obtaining institutional review board approval, we conducted a retrospective descriptive study of all consecutive patients, admitted to our cardiothoracic ICU for MV, between January 2011 and May Patients receiving a tracheostomy before 10 days of MV were assigned the 'early tracheostomy group'. Patients receiving a tracheostomy after and including 10 days of MV were assigned the 'late tracheostomy group'. Descriptive statistics were used to summarize data. Results: A total of 8136 patients were included. Mean age was 62 years. Of these patients, 232 (2.85%) underwent tracheostomy. 223 patients received a bedside percutaneous tracheostomy and 9 patients received a surgical tracheostomy. The mean time of tracheostomy formation within our ICU was 10 days % of patients were admitted to ICU post-cardiothoracic surgery, 11.2% post-transplant surgery (either cardiac transplant, single or bilateral lung transplant or cardiac and lung transplant), 20.26% were non-surgical admissions, 10.34% were admitted with acute cardiorespiratory failure requiring extracorporeal life support (ECLS) and 3.02% after percutaneous coronary intervention. The mean total days of MV in the early group was /-SE1.57 vs /-SE 2.00 in the late group (p= ). The mean length of ICU stay in the early group was 38+/-SE10 vs /-SE 7.39 in the late group (Tables 1-4, Figure 1). In total, 105 patients (45.26%) had a tracheostomy-related complication. The three most commonly reported complications were: bleeding (9.05%), occlusion of the tracheostomy tube (10.78%) and air leak (5.60%) (Figure 2). Bleeding was the most common complication in the ECLS patients (33.33%). 6 patients (2.59%) suffered cardiorespiratory arrest secondary to tracheostomy associated causes and they were successfully resuscitated. 1 patient died due a tracheostomy-related cause (secondary hemorrhage and airway obstruction). Fewer tracheostomy related complications were observed in the early group (43%) in comparison to the late group (50%). Conclusion: Our data suggest that failure of our cardiothoracic ICU patient to separate from MV within 10 days, is predictive of eventual requirement for tracheostomy formation. The overall post-operative complication rate of tracheostomy within our ICU was high, hemorrhage being the most common among ECLS patients. Although we have not used a strict definition of bleeding, this finding suggests the need for increased awareness and careful risk stratification

2 prior to performing a tracheostomy on anticoagulated and often coagulopathic cardiothoracic ICU patients. References: 1. Huang H, Li Y, Ariani F, Chen X, Lin J. Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS One Mar 25;9(3):e Young et al Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical Ventilation The TracMan Randomized Trial JAMA 309(20): Diehl JL, El Atrous S, Touchard D, et al. Changes in the work of breathing induced by tracheotomy in ventilatordependent patients. Am J Respir Crit Care Med 1999; 159: Plummer AL, Gracey DR. 4. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96: Wang F, Wu Y, Bo L, et al. The timing of tracheostomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials.chest 2011;140(6): Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 1985;87(6):715-9.

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