Free On-line Access

SPCI - Sociedade Portuguesa de Cuidados Intensivos

Revista Brasileira de Terapia Intensiva

AMIB - Associação de Medicina Intensiva Brasileira


ISSN: 0103-507X
Online ISSN: 1982-4335

Ícone Fechar

How to Cite


Oliveira CD, Peixoto LC, Nangino GO, Correia PC, Isoni CA. Aspectos epidemiológicos de pacientes traqueostomizados em unidade de terapia intensiva adulto de um hospital de referência ao Sistema Único de Saúde em Belo Horizonte. Rev Bras Ter Intensiva. 2010;22(1):47-52



Original Article

Epidemiological profile of patients with tracheotomy in a referral public hospital intensive care unit in Belo Horizonte

Aspectos epidemiológicos de pacientes traqueostomizados em unidade de terapia intensiva adulto de um hospital de referência ao Sistema Único de Saúde em Belo Horizonte

Cláudio Dornas de OliveiraI, Leonardo da Cruz PeixotoII, Gláucio Oliveira NanginoIII, Paulo César CorreiaIV, Camila Armond IsoniV

IPhysician of the Intensive Care Unit of Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil
IIPhysician of Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil
IIIPhysician of the Intensive Care Unit of Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil
IVPhysician of the Intensive Care Unit of the Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil
VMedical Graduation Student, Trainee at the Intensive Care Unit of Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil

Submitted on April 13, 2009
Accepted on March 10, 2010

Corresponding author:

Cláudio Dornas de Oliveira
Santa Casa de Belo Horizonte - CTI Adulto
Av. Francisco Sales, 1111 - 2º andar - Santa Efigênia
CEP: 30150-221 - Belo Horizonte (MG), Brazil
Phone: +55 31 3238-8181 / 3238-8761
E-mail: [email protected]



OBJETIVES: Tracheostomy is a common procedure in intensive care unit to promote mechanical ventilation weaning. Despite tracheostomy is increasingly used there is no agreement of actual clinical practice of tracheostomy in different groups of patients in our environment. Objective of this study was to evaluate the epidemiological profile and outcomes of patients with tracheostomy at a clinical-surgical intensive care unit and compare this profile with the current literature.
METHODS: Retrospective descriptive study through review of medical records and quality control database of "QuaTI" (Qualidade em Terapia Intensiva) of 87 patients with tracheostomy at Santa Casa de Belo Horizonte intensive care unit in 2007. We studied variables related to evolution aspects.
RESULTS: The clinical and epidemiological analysis of the 87 patients showed: mean age 58 ± 17 years, mean Acute Physiology and Chronic Health Evaluation - APACHE II 18 ± 6, mean time of orotracheal intubation before tracheostomy of 11.17 ± 4.78 days. Intensive care unit mortality was 40.2% (35/87 patients), ward mortality was 36.5% (19/52) and overall hospital mortality 62.1% (54/87). Mean age of patients who died at intensive care unit (65 + 17 years) was greater than who were discharged to ward (53 ± 16 years) p = 0.003. Mean age of who died in hospital (intensive care unit and ward) (62 ± 17 years) was also higher than survivors (52 ± 16 years) p = 0.008. Old age (> 65 years) was related to intensive care unit mortality (OR 2.874, CI 1.165 a 7.088 p = 0.020) and also related to the overall hospital mortality (OR 3.202, CI 1.188 a 8.628 p = 0.019). There were not others variables related to mortality in this sample.
CONCLUSIONS: The epidemiological profile of patients who underwent tracheostomy in the intensive care unit showed high mortality rate when compared to international series. Senility was related to worse outcome in these patients. Other issues were not related mortality in this group.

Keywords: Ventilator weaning, Respiration artificial, Age, Tracheostomy




Tracheostomy is a frequent surgical procedure for intensive care patients, and is increasingly being used earlier to support mechanical ventilation weaning.(1) Relative to prolonged trans-laryngeal intubation, potential advantages of tracheostomy include patient's comfort;(2) safe airway access;(3) reduced tube-related laryngo-tracheal injuries(4) and mechanic ventilation time reduction.(5-7) However, the tracheostomy benefits are not fully established.(8) Tracheostomy practices varies substantively among different services(9-11) and data from clinical trials on its impact are lacking.(12) Recent reviews recommend the use of percutaneous-bronchoscopy technique(13) as a safe and with less wound infections, and early tracheostomy in patients expected to have long term trans-laryngeal intubation.(13-17) Other tracheostomy-related aspects in different patients groups remain unclear.

This work aimed to retrospectively evaluate the epidemiological aspects of patients undergoing tracheostomy while staying in the intensive care unit (ICU) of the Santa Casa de Belo Horizonte (SCBH), and to compare the results to the literature.



Medical records and the "QuaTI" (Qualidade em Terapia Intensiva [Intensive Care Quality]) data bank were analyzed for 100 patients who underwent tracheostomy from January-December, 2007 in an intensive care unit encompassing a clinical ICU, a general pos-operative ICU and a post-cardiovascular surgery ICU, totalizing 29 beds. The patients were included according to the SCBH's Chest Surgery team data. Thirteen patients with incomplete information were excluded. Tracheostomy was perfomed for mechanic ventilation weaning in all patients selected. In 87 patients the following variables were studied: age, gender, admission diagnosis, chronic pulmonary disease, ICU and hospital stay length after tracheostomy, early or late tracheostomy, ICU and hospital death rates. Early tracheostomy was defined as occurring within < 7 days, based on previous studies.(13-15)

Statistical analysis

The quantitative variables were expressed as mean ± standard deviation or median and interquartiles [25-75 percentiles] according to the samples distribution. The variables were compared using the t Student or Mann-Whitney tests according to the distribution normality. The sample's distribution was obtained with the Kolgomorov-Smirnov test. The categorical variables were expressed as numbers/totals and percentages, and the comparison used the Chi-square or the Fisher's tests. A p<0.05 value was considered significant. This study was approved by the SCBH's Ethics Committee, according to the approval document 016/2008.



Sample's description

The 87 patient's clinical and epidemiological analysis showed a mean age of 58 ± 17 years, 55,2% were male and with a mean Acute Physiological Chronic Health Evaluation (APACHE II) score of 18 ± 6 (Table 1). Clinical admissions mounted 59.7% (52 patients); among the causes: sepsis (19 [21.8%]); respiratory failure (18 [20.6%]); acute myocardial infarction (6 [6.8%]); acute renal failure (3 [3.4%]); congestive heart failure (2 [2.2%]); heart arrhythmia (1 [1.1%]); stroke (1 [1.1%]); ketoacidosis (1 [1.1%]) and hemorrhagic fever (1 [1.1%]). Surgical patients (34) were 39.1% of the total. From these, 10 (11.5%) were post heart surgery; 9 (10.3%) post neurological surgery; 8 (9.2%) post digestive system surgery; 7 (8.0%) for other surgeries post-operative period. One single case was admitted for trauma. The tracheostomy was performed by the percutaneous dilatational tracheostomy technique in 7 patients (8.0%). The patients in this sample were intubated for a mean 11.17 ± 4.8 days. The tracheostomy was performed early (< 7 days) in 23/87 patients (26.4%); it was late (> 7 days) in 64/87 patients (73.6%) (Table 2). The mean length of stay in ICU after the tracheostomy was 13 days (8-22) and the mean hospital stay after the procedure was 44 ± 27 days.

Intensive care unit and hospital mortality-related aspects

The mortality rate in the ICU was 40.2% (35/87 patients), after ICU discharge (in the ward) was 36.5% (19/52) and the overall hospital mortality rate was 62.1% (54/87). No death or serious complication was procedure-related. No ICU and overall hospital mortality differences were identified between clinical and surgical patients.

Comparing timing (early or late), no difference was seen regarding ICU or hospital length of stay after tracheostomy, and ICU and hospital mortality rate (Table 2).

The mean ICU dead patients' age (64.9 ± 17 years) was higher than for those discharged from the ICU (53.7 ± 16 years) p = 0.003 (Table 3). Equally, the mean age of the patients who died in the hospital (both ICU and ward) (62 ± 17 years) was higher than the survivors' (52 ± 16 years) p = 0.008 (Table 4). Senility (age > 65 years) was an ICU mortality-related factor (OR 2.874; CI 1.165-7.088) p = 0.020) (Table 3), and also related with the overall hospital mortality rate (p = 0.019, OR 3.202; CI (1.188-8.628) (Table 4). No other mortality-related variables were found in this sample. These data comparison with other Brazilian and international studies are shown on charts 1 and 2.



This study has shown high tracheostomy patients' mortality rate. We emphasize that no death was related to the procedure. International data show lower death rates (13.7-39%) for patients with these characteristics (Chart 1).(11,18,19)

In Brazil, data are lacking and controversial (Chart 2). Aranha et al. identified low mortality rates in tracheostomy patients, and additionally, identified lower ICU mortality versus trans-laryngeal intubation patients (21.8% versus 61.9%, p = 0.001).(20) Pasini et al., in a young head trauma patients study found a low mortality rate.(21) Santos et al. found 49.5% ICU mortality(22) and more recently, Perfeito et al. found 63% hospital mortality.(23) The tracheostomy patients' mortality rate variation may be either from individual ICUs tracheostomy indications, weaning protocols, and patients' epidemiological profiles.(8) In this study ICU, tracheostomy is indicated by individual approach, and the mechanic ventilation weaning protocol involves daily disconnections, and in refractory cases, progressive time disconnections. In this sample, the mean orotracheal intubation time was 11 days, similar to large international surveys (11 days for Etaban et al.(24) and 12 days for Frutos-Vivar et al.(19) The percutaneous dilatational tracheostomy technique was used in 7 patients only.

The study hospital is a high complexity Governmental health system referral hospital. We believe our sample's epidemiological profile involved severely ill patients due to the repressed demand for intensive care unit beds, resulting in admitions of patients with ongoing therapy, already under mechanic ventilation and with pressure levels corrected with vasoactive, and also corrected metabolic disorders, thus leading APACHE II score underestimation.

The comparative analysis has shown that the patients who died were older, and that the elderly have increased ICU and overall hospital mortality rates. This is consistent with the international literature.(24-27) Evidences suggest that old age determines independent adverse prognosis for mechanic ventilation patients.(22,24) Specially for tracheostomy patients, it was shown that older subjects have increased post-ICU discharge mortality.(28) Baskin et al. suggest that strict criteria should be considered when indicating tracheostomy in mechanically ventilated elderly patient.(29) It is highlighted that other aspects such as comorbidities, previous cognitive disorders and functional dependency may be involved in these patients outcomes.

Tracheostomy patients' care and follow-up should be individualized. Semi-intensive units and multi-disciplinary teams could reduce mortality rates in this group of patients. Invasive mechanic ventilation indication-related strategies, mechanic ventilation weaning, and timing of tracheostomy should be further investigated.

Study limitations

This study has relevant limitations such as: 1) it was a retrospective analysis involving medical records and databank evaluation, and this prevented the analysis of relevant variables such as sensorial level, nutritional status and mechanic ventilation associated pneumonia; 2) this study was developed in one single center; 3) the small sample size prevented appropriate comparisons between the groups, such as between dilational percutaneous and surgical bedside tracheostomy techniques.



The epidemiological profile of these tracheostomy patients has shown increased mortality rate as compared to international studies. Old age was the only mortality-related variable in this sample. Individual follow-up is suggested. Further studies are warranted on predictive factors and possible therapeutic strategies identification.



1. Groves DS, Durbin CG Jr. Tracheostomy in the critically ill: indications, timing and techniques. Curr Opin Crit Care. 2007;13(1):90-7.

2. Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, Chastre J. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33(11):2527-33.

3. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ. Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg. 2000;123(4):495-500. Review.

4. Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981;70(1):65-76.

5. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005;9(1):R46-52.

6. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;330(7502):1243.

7. Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008;36(9):2547-57.

8. Salcedo O, Frutos-Vivar F. [Tracheostomy in ventilated patients. What do we do it for?] Med Intensiva. 2008;32(2):91-3. Spanish.

9. Blot F, Melot C; Commission d'Epidémiologie et de Recherche Clinique. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127(4):1347-52.

10. Krishnan K, Elliot SC, Mallick A. The current practice of tracheostomy in the United Kingdom: a postal survey. Anaesthesia. 2005;60(4):360-4.

11. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med. 2005;33(11):2513-20.

12. Scales DC, Kahn JM. Tracheostomy timing, enrollment and power in ICU clinical trials. Intensive Care Med. 2008;34(10):1743-5.

13. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, Van Meerhaeghe A, Van Schil P; Belgian Association of Pneumology and Belgian Association of Cardiothoracic Surgery. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32(3):412-21.

14. Rodrigues JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990;108(4):655-9.

15. Möller MG, Slaikeu JD, Bonelli P, Davis AT, Hoogeboom JE, Bonnell BW. Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg. 2005;189(3):293-6.

16. King C, Moores LK. Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med. 2008;29(2):253-63, vi.

17. Goldwasser R, Farias A, Freitas EE, Saddy F, Amado V, Okamoto VN. Desmame e interrupção de ventilação mecânica. Rev Bras Ter Intensiva. 2007;19(3):384-92.

18. Kollef MH, Ahrens TS, Shannon W. Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med. 1999;27(9):1714-20.

19. Frutos-Vivar F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, Soto L, Rodrigo C, Raad J, David CM, Matamis D, D' Empaire G; International Mechanical Ventilation Study Group. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med. 2005;33(2):290-8.

20. Aranha SC, Mataloun SE, Moock M, Ribeiro R. Estudo comparativo entre traqueostomia precoce e tardia em pacientes sob ventilação mecânica. Rev Bras Ter Intensiva. 2007;19(4):444-9.

21. Pasini RL, Fernandes YB, Araújo S, Soares SMTP. A influência da traqueostomia precoce no desmame ventilatório de pacientes com traumatismo crânioencefálico grave. Rev Bras Ter Intensiva. 2007;19(2):176-81.

22. Santos MAR, Vieira MBM, Maia AF, A. Filho FE, Guimarães RES, Borges TJA, et al. Técnicas de abertura traqueal na traqueostomia: estudo prospective randomizado. BJORL Braz J Otorhinolaringol. 1996;62(5):409-14.

23. Perfeito JAJ, Mata CAS, Forte V, Carnaghi M, Tamura N, Leão LEV. Tracheostomy in the ICU: is it worthwhile? J Bras Pneumol. 2007;33(6):687-90.

24. Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450-8.

25. Cohen IL, Lambrinos J. Investigating the impact of age on outcome of mechanical ventilation using a population of 41,848 patients from a statewide database. Chest. 1995;107(6):1673-80.

26. Grace RF, Gosley M, Smith P. Mortality and outcomes of elderly patients admitted to the intensive care unit at Cairns Base Hospital, Australia. Crit Care Resusc. 2007;9(4):334-7.

27. Cox CE, Carson SS, Lindquist JH, Olsen MK, Govert JA, Chelluri L; Quality of Life After Mechanical Ventilation in the Aged (QOL-MV) Investigators. Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study. Crit Care. 2007;11(1):R9.

28. Gordo F, Núñez A, Calvo E, Algora A. [Intrahospital mortality after discharge from the ICU (hidden mortality) in patients who required mechanical ventilation]. Med Clin (Barc). 2003;121(7):241-4. Spanish.

29. Baskin JZ, Panagopoulos G, Parks C, Rothstein S, Komisar A. Clinical outcomes for the elderly patient receiving a tracheotomy. Head Neck. 2004;26(1):71-5.



Received from Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.



Submission On-line

Indexed in




Associação de Medicina Intensiva Brasileira - AMIB

Rua Arminda nº 93 - 7º andar - Vila Olímpia - São Paulo, SP, Brasil - Tel./Fax: (55 11) 5089-2642 | e-mail: [email protected]

Cookie Policy

GN1 - Systems and Publications