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Study of Demographic Profile of Organophosphate Compound Poisoning with Special Reference to Early Versus Late Tracheostomy in Tertiary Care Hospital in Rural Area

  • M. A. KawaleEmail author
  • S. H. Gawarle
  • P. N. Keche
  • S. V. Bhat
Original Article
  • 27 Downloads

Abstract

Tracheostomy is commonly performed life saving procedure. Organophosphorus compound poisoning is a very common emergency encountered in rural area where major population consists of agricultural workers. Ideal timing of tracheostomy is still controversial. Aim of the study is to assess the advantage of performing early (48 h–7 days) versus late tracheostomy (8–15 days) with regard to weaning from a ventilator, complications and length of hospital stay. This is a comparative retrospective interventional study in which 100 patients of organophosphorus poisoning who underwent tracheostomy during hospital stay due to prolonged intubation were analyzed. Study subjects were divided into two groups. Each group constitute of 50 patients each. Group A: Early tracheostomy (48 h–7 days) and Group B: Late tracheostomy (8–15 days). Early tracheostomy required a shorter duration of mechanical ventilator support (4–5 days) when compared to late tracheostomy (5–8 days), p < 0.05 and early tracheostomy facilitate early weaning. There was high incidence of complications in late tracheostomy group as compare to early tracheostomy group. Duration of hospital stay was also longer in Group B (mean 40 days) as compare to Group A (mean 32 days) with p < 0.05. We concluded that, early tracheostomy was associated with shorter duration of mechanical ventilator support, it helps for early weaning, shorted intensive care unit and hospital stay as compare to late tracheostomy.

Keywords

Tracheostomy ICU Length of hospital stay Organophosphorus poisoning Weaning Mechanical ventilation 

Notes

Acknowledgement

The authors would like to thank the department of ENT, Surgery, other staff of operation theatre and administration of Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, for permission to study and providing facility to carry out the work.

Compliance with Ethical Standards

Conflict of interest

All author declare that they have no conflict of interest.

Ethical Approval

Permission of Institutional Ethics Committee was taken and written and informed consent was obtained from the patient or his relatives/parents (in case of minor) before starting the tracheostomy procedure. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Pracy P (2008) Tracheostomy in Scott-Brown’s otolaryngology. In: Head and neck surgery, 7th edn, vol 2. Hodder ArnoldGoogle Scholar
  2. 2.
    Bradley PJ (1997) Management of the obstructed airway and tracheostomy. In: Scott-Brown’s otorhinolaryngology, head and neck surgery 6 th edn, vol 5. Butterworth-HeinemannGoogle Scholar
  3. 3.
    Klunge S, Baumann HJ, Maier C, Klose H, Meyer A, Nierhaus A, Kreymann G (2008) Tracheostomy in intensive care unit: a nationwide survey. Anesth Analg 107(5):1639–1643CrossRefGoogle Scholar
  4. 4.
    Boubaker C, Abdelhamid H, Abdellatif B et al (2009) Tracheostomy versus prolonged intubation in medical intensive care unit. Signa Vitae 4(1):21–23CrossRefGoogle Scholar
  5. 5.
    Zheng X, Zhu J, Yu Q (2011) Current situation and advance of APACHE-II score in clinical application. Med Recapitulate 21:034Google Scholar
  6. 6.
    Sam KG, Kondabolu K, Pati D, Kamath A, Kumar GP, Rao PG (2009) Poisoning severity score, APACHE II and GCS effective clinical indices for estimating severity and predicting outcome of acute organophosphorus and carbamate poisoning. J Forensic Leg Med 16:239–247.  https://doi.org/10.1016/jflm.2008.12.2004 PubMedCrossRefGoogle Scholar
  7. 7.
    Heffner JE, Hess D (2001) Tracheostomy management in the chronically ventilated patient. Clin Chest Med 22(1):55–69PubMedCrossRefGoogle Scholar
  8. 8.
    Criner GJ, Tzouanakis A, Kreimer DT (1994) Overview of improving tolerance of long-term mechanical ventilation. Crit Care Clin 10(4):845–866PubMedCrossRefGoogle Scholar
  9. 9.
    Armstrong PA, McCarthy MC, Peoples JB (1998) Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery 124(4):763–766PubMedCrossRefGoogle Scholar
  10. 10.
    Plummer AL, Gracey DR (1989) Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 96(1):178–180PubMedCrossRefGoogle Scholar
  11. 11.
    Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 32(8):1689–1694PubMedCrossRefGoogle Scholar
  12. 12.
    Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB et al (2010) Early vs late tracheotomyfor prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 303(15):1483–1489PubMedCrossRefGoogle Scholar
  13. 13.
    Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM (1990) Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 108(4):655–659PubMedGoogle Scholar
  14. 14.
    Arabi Y, Haddad S, Shirawi N, Al Shimemeri A (2004) Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care 8(5):R347–R352PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Lesnik I, Rappaport W, Fulginiti J, Witzke D (1992) The role of earlytracheostomy in blunt, multiple organ trauma. Am Surg 58(6):346–349PubMedGoogle Scholar
  16. 16.
    D’amelio LF, Hammond JS, Spain DA, Sutyak JP (1994) Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head injured trauma patient. Am Surg 60(3):180–185PubMedGoogle Scholar
  17. 17.
    Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A (2004) Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Acute Care Surg 57(2):251–254CrossRefGoogle Scholar
  18. 18.
    Brook AD, Sherman G, Malen J, Kollef MH (2000) Early versus late tracheostomy in patients who require prolonged mechanical ventilation. Am J Crit Care 9(5):352–359PubMedGoogle Scholar
  19. 19.
    Sugerman HJ, Wolfe L, Pasquale MD, Rogers FB, O’Malley KF, Knudson M et al (1997) Multicenter, randomized, prospective trial of early tracheostomy. J Trauma Acute Care Surg 43(5):741–747CrossRefGoogle Scholar
  20. 20.
    Griffiths J, Barber VS, Morgan L, Young JD (2005) Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330(7502):1243PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Dunham CM, Ransom KJ (2006) Assessment of early tracheostomy in trauma patients: a systemic review and meta-analysis. Am Surg 72:276–281PubMedGoogle Scholar
  22. 22.
    Wang F, Wu Y, Bo L et al (2011) The timing of tracheostomy in critically ill patients undergoing mechanical ventilation: a systemic review and meta-analysis of randomized controlled trials. Chest 140:1456–1465PubMedCrossRefGoogle Scholar
  23. 23.
    Major KM, Hui T, Wilson MT, Gaon MD, Shabot MM, Margulies DR (2003) Objective indications for early tracheostomy after blunt head trauma. Am J Surg 186(6):615–619 (discussion 619) PubMedCrossRefGoogle Scholar
  24. 24.
    Bylappa K, Mohiyudin A, Delphine W, Silivia CR, Krishnamurthy D, Pyarajan MS (2011) A comparative study f early and late tracheostomy in patients requiring proloned tracheal intubation. Dec 31, 2011. http://www.waent.org/archives/2011/vol4-2/20111215-Treacheostomy-Intubation/late–tracheostomy.Htm. Accessed 11 May 2014
  25. 25.
    Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC (2005) Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care 9(1):R46–R52PubMedCrossRefGoogle Scholar
  26. 26.
    Brandwein M, Abramson AL, Shikowitz MJ (1986) Bilateral vocal cord paralysis following endotracheal intubation. Arch Otolaryngol Head Neck Surg 112:866–882CrossRefGoogle Scholar
  27. 27.
    Cavo JW Jr (1985) True vocal cord paralysis following intubation. Laryngoscope 95:1352–1359PubMedCrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • M. A. Kawale
    • 1
    Email author
  • S. H. Gawarle
    • 1
  • P. N. Keche
    • 2
  • S. V. Bhat
    • 1
  1. 1.SVNGMCYavatmalIndia
  2. 2.Government Cancer HospitalAurangabadIndia

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