Scientific and Technological Research
Patients with tracheostomy indication in an intensive care cohort
Pacientes con indicación de traqueostomía en una cohorte de cuidados intensivos
María Esther Martínez-Barrio
, Ana Berrazueta-S. de Vega, Javier Romero-Pellejero, José Antonio Fernández-Ratero, Maria del Valle-Ortiz, Diana Armesto-Formoso
Corresponding author
esmaba12@yahoo.es
Corresponding author at: Hospital Universitario de Burgos, Avenida Islas Baleares, 3, 09006 Burgos, Spain.
Corresponding author at: Hospital Universitario de Burgos, Avenida Islas Baleares, 3, 09006 Burgos, Spain.
Intensive Care Unite, Burgos University Hospital, Burgos, Spain
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There is an ongoing debate with regards to the technique, the timing of the procedure, the impact of duration of mechanical ventilation<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> (MV), length of stay, and mortality.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> The best time to do the TC is still being debated.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The contradictory results in the literature, and the lack of evidence in favor of early tracheostomy warrant further research to contribute with additional information about the procedure. The objective of the study was to describe the characteristics of patients with indication for TC, comparing early versus late groups.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">An observational, descriptive study was performed in a cohort of patients admitted to the ICU with indication for tracheostomy during 2012. The patients undergoing tracheostomy were selected analyzing the demographics, the underlying pathologies (classified as critical neurological patients, multiple trauma patients, state of shock and respiratory failure), severity scale at the time of admission (Apache II), type of technique (percutaneous or surgical), complications (immediate and late), duration of MV, length of stay in the ICU, and survival. Patients with a history of laryngectomy, emergency procedure due to airway obstruction, or limitations for life support therapy were excluded.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Following the indication for TC approved by consensus during a clinical session, the elective procedure was performed as per the current protocol. The study was approved according to the rules of the Ethics Committee on Clinical Research. The technique was decided based on the cervical anatomy and the clinical situation. The percutaneous approach was safe and avoided transferring the patient. The surgical approach is the first line option in the presence of cervical pathology or anatomical alterations. This procedure was performed at the ICU unit or by ENT for more complex cases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">According to the model, the patients were classified as early and late TC, from day 14. The recent evidence<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> recommends waiting 10 days to confirm the need for MV before indicating the procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A prospective review of the medical records was performed, collecting variables and developing a database for further analysis. The categorical variables are expressed as percentages and frequency distributions, while the quantitative variables are expressed as means (95% CI) or medians (IQR). The contrasting hypotheses tests used for the quantitative variables were the <span class="elsevierStyleItalic">t</span>-Student test for the comparison of parametric measures and Mann–Whitney <span class="elsevierStyleItalic">U</span> test for the non-parametric. The chi-square test was used for the qualitative variables.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The mean age of the sample (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42) was 61.36 years, with 69% males. The mean Apache II was 18, IQR [13–20]. The most frequent pathology was neurological critical patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The percutaneous approach was used in 71.5% of the cases with 19% immediate complications reported and 16.7% late complications. The survival was 64.3%.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The mean number of days in MV until the TC was 14 IQR [9–17]; the mean number of total days in MV was 26.52 with 95% CI (22.44–30.61); and the mean length of stay was 28.05 with 95% CI (23.85–32.24). The cases were classified into groups: early TC performed before or on day 14 of MV (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27, 64.3% of the sample); and late TC after day 14 of MV, (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15, 35.7% of the sample). Both groups were comparable in terms of age, gender, and Apache II severity scale (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). For the variables of total days in MV and length of stay, significant differences were identified, with higher mean values among the late TC group. There was no significant association between the TC time and survival (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">TC is a technique frequently indicated in patients requiring extended MV. In our study the mean age was 61 years, with predominantly male patients. The most frequently used approach was percutaneous with a rate of complications of less than 20%, being a safe technique. The best timing to do the procedure is not yet defined. The median time in MV until the procedure was performed was 14 days. The patients in the early TC group has less days in MV and shorter length of stay as compared against the late TC group. These results are comparable to those in previous meta-analyses.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> By contrast, there were no differences in terms of mortality, in accordance with recent publications.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Further research shall consider the heterogeneity of the patients included depending on the pathology. In neurological critical patients and/or patients with a high probability of extended MV, the early TC reduces the number of days in MV and the length of stay in the ICU,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> with no impact on mortality.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financing</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to carry out this article.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres737121" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec741220" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres737122" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec741221" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Financing" ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-23" "fechaAceptado" => "2016-06-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec741220" "palabras" => array:5 [ 0 => "Tracheostomy" 1 => "Critical care" 2 => "Respiration, artificial" 3 => "Airway management" 4 => "Intensive care units" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec741221" "palabras" => array:5 [ 0 => "Traqueostomía" 1 => "Cuidados críticos" 2 => "Respiración artificial" 3 => "Manejo de la vía aérea" 4 => "Unidades de cuidados intensivos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tracheostomy is a procedure indicated for patients with extended mechanical ventilation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The objective of the study was to learn about the technical characteristics, the appropriate timing for the procedure and its evolution.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Observational, retrospective study of ICU admitted patients during 2012, with elective tracheostomy. The demographic variables, the Apache II, the pathologies, the number of days in MV, length of stay and mortality were analyzed, both globally and by groups, depending on the early or late use of the technique. The study was approved by the Ethics Committee for Clinical Research of the institution, in accordance with the institutional bioethical principles.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The mean age in the sample with 42 patients was 61.36, and the mean Apache II was 18. The most frequent pathology was neurological. The approach was percutaneous in 71.5%, with minor complications in 20% of the cases. In the early tracheostomy group, the number of days in MV and the length of stay were both considerably shorter.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Elective tracheostomy is a commonly used technique in the ICU and the procedure is performed according to the protocol. The percutaneous approach is the most frequently used, with few complications. In neurological critical patients with extended weaning, an early approach reduces the number of days with ventilation and the length of stay, with no positive impact on mortality.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La traqueostomía es un procedimiento indicado en los pacientes con ventilación mecánica prolongada.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio fue conocer sus características, técnica, momento adecuado de realización y evolución.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo, de pacientes ingresados en UCI durante 2012, con traqueostomía electiva. Se analizaron variables demográficas, escala Apache II, patologías, días de VM, estancia y mortalidad; de forma global, y por grupos según técnica precoz o tardía. El estudio fue aprobado por el Comité Ético de Investigación Clínica del centro, cumpliendo con los principios bioéticos del mismo.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En la muestra de 42 pacientes la edad media fue 61.36, con mediana de Apache II de 18. La patología más frecuente fueron los pacientes neurológicos, se realizó la forma percutánea en el 71.5%, con complicaciones menores del 20%. En el grupo de traqueostomía precoz se observó menor número de días de VM y estancia de forma significativa.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La traqueostomía electiva es una técnica frecuente en UCI, realizado el procedimiento según protocolo; la modalidad percutánea es la más empleada, con escasas complicaciones. En los pacientes neurocríticos y con destete prolongado la técnica precoz reduce los días de ventilación y estancia, sin beneficio en la mortalidad.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Martínez-Barrio ME, Berrazueta-S. de Vega A, Romero-Pellejero J, Fernández-Ratero JA, del Valle-Ortiz M, Armesto-Formoso D. Pacientes con indicación de traqueostomía en una cohorte de cuidados intensivos. Rev Colomb Anestesiol. 2016;44:278–281.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pathologies \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Number of cases (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological critical pts<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (47.61%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (7.14%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shock (septic and hypovolemic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (14.28%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (30.95%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1217091.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Head and neck trauma, CVA, Status epilepticus.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Medical pathologies with extended mechanical ventilation.</p> <p class="elsevierStyleNotepara" id="npar0015">Source: authors.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Principal diagnoses for ICU admission with tracheostomy indication (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">MV, mechanical ventilation.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">IQR, inter quartile range, percentile 25–percentile 75.</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Source: authors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Early tracheostomy<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Late tracheostomy<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (mean in years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.428 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender % (males/females) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66.7/33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73.3/26.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.654 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Apache II Mean, IQR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17[13–20] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 [14– 20] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.562 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1217093.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Group characteristics of groups in terms of the timing of the procedure: early (up to 14 days in MV), late (after 14 days in MV).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">MV, mechanical ventilation.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Source: authors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Sample<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Early tracheostomy<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Late tracheostomy<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Days in ventilation (mean, 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.52 (22.44–30.61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.37 (18.37–25.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.80 (29.43–43.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of stay (mean, 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28.05 (23.85–32.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.19 (19.58–27.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.80 (30.35–44.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Survival % (Recovery/exitus) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64.3/35.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74/26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46.7/53.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.076 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1217092.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Comparison of number of days in mechanical ventilation, length of stay, and survival Early technique (up to 14 days in MV), late (after 14 days in MV).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of time to tracheostomy on mechanical ventilation duration, length of stay and mortality in intensive care unit patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 11 | 3 | 14 |
| 2024 September | 24 | 5 | 29 |
| 2024 August | 19 | 2 | 21 |
| 2024 July | 15 | 6 | 21 |
| 2024 June | 11 | 3 | 14 |
| 2024 May | 18 | 2 | 20 |
| 2024 April | 26 | 7 | 33 |
| 2024 March | 38 | 9 | 47 |
| 2024 February | 38 | 5 | 43 |
| 2024 January | 15 | 3 | 18 |
| 2023 December | 20 | 9 | 29 |
| 2023 November | 41 | 9 | 50 |
| 2023 October | 27 | 10 | 37 |
| 2023 September | 11 | 3 | 14 |
| 2023 August | 17 | 6 | 23 |
| 2023 July | 9 | 3 | 12 |
| 2023 June | 15 | 0 | 15 |
| 2023 May | 33 | 5 | 38 |
| 2023 April | 28 | 1 | 29 |
| 2023 March | 25 | 2 | 27 |
| 2023 February | 32 | 4 | 36 |
| 2023 January | 13 | 6 | 19 |
| 2022 December | 24 | 7 | 31 |
| 2022 November | 18 | 3 | 21 |
| 2022 October | 27 | 9 | 36 |
| 2022 September | 9 | 11 | 20 |
| 2022 August | 23 | 9 | 32 |
| 2022 July | 18 | 8 | 26 |
| 2022 June | 13 | 10 | 23 |
| 2022 May | 37 | 3 | 40 |
| 2022 April | 24 | 6 | 30 |
| 2022 March | 18 | 11 | 29 |
| 2022 February | 20 | 4 | 24 |
| 2022 January | 35 | 11 | 46 |
| 2021 December | 8 | 13 | 21 |
| 2021 November | 13 | 8 | 21 |
| 2021 October | 16 | 10 | 26 |
| 2021 September | 9 | 10 | 19 |
| 2021 August | 11 | 9 | 20 |
| 2021 July | 11 | 8 | 19 |
| 2021 June | 15 | 13 | 28 |
| 2021 May | 9 | 7 | 16 |
| 2021 April | 11 | 10 | 21 |
| 2021 March | 22 | 3 | 25 |
| 2021 February | 11 | 12 | 23 |
| 2021 January | 4 | 10 | 14 |
| 2020 December | 5 | 4 | 9 |
| 2020 November | 6 | 5 | 11 |
| 2020 October | 3 | 2 | 5 |
| 2020 September | 7 | 5 | 12 |
| 2020 August | 6 | 4 | 10 |
| 2020 July | 4 | 12 | 16 |
| 2020 June | 4 | 3 | 7 |
| 2020 May | 5 | 4 | 9 |
| 2020 April | 7 | 3 | 10 |
| 2020 March | 3 | 4 | 7 |
| 2020 February | 3 | 2 | 5 |
| 2020 January | 5 | 3 | 8 |
| 2019 December | 6 | 3 | 9 |
| 2019 November | 3 | 1 | 4 |
| 2019 October | 4 | 0 | 4 |
| 2019 September | 2 | 2 | 4 |
| 2019 July | 3 | 8 | 11 |
| 2019 June | 0 | 2 | 2 |
| 2019 May | 1 | 11 | 12 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 2 | 4 | 6 |
| 2018 May | 25 | 5 | 30 |
| 2018 April | 29 | 5 | 34 |
| 2018 March | 20 | 9 | 29 |
| 2018 February | 13 | 6 | 19 |
| 2018 January | 16 | 6 | 22 |
| 2017 December | 16 | 6 | 22 |
| 2017 November | 9 | 6 | 15 |
| 2017 October | 29 | 7 | 36 |
| 2017 September | 13 | 9 | 22 |
| 2017 August | 8 | 5 | 13 |
| 2017 July | 29 | 5 | 34 |
| 2017 June | 28 | 22 | 50 |
| 2017 May | 28 | 8 | 36 |
| 2017 April | 38 | 8 | 46 |
| 2017 March | 19 | 9 | 28 |
| 2017 February | 9 | 2 | 11 |
| 2017 January | 23 | 7 | 30 |
| 2016 December | 60 | 18 | 78 |
| 2016 November | 47 | 14 | 61 |
| 2016 October | 73 | 25 | 98 |
| 2016 September | 12 | 4 | 16 |
| 2016 August | 3 | 2 | 5 |
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