Traqueostomía Percutánea Híbrida Temprana vs Tardía en Terapia Intensiva: Cohorte Retrospectiva Boliviana
Palabras clave:
América Latina, Análisis de supervivencia, Calidad de vida, Traqueostomía, Unidades de cuidados intensivos, Ventilación mecánicaResumen
Introducción: La traqueostomía híbrida combina la técnica quirúrgica y percutánea; se utiliza más en unidades de terapia intensiva, con recursos limitados. Pero persiste la incertidumbre sobre el momento de su realización. Objetivo: Evaluar si la realización temprana (≤ 7 días) frente a tardía (> 7 días) de la traqueostomía híbrida se asocia con la mortalidad intrahospitalaria, el alta viva y los días vivos y fuera del hospital (DAOH) en pacientes críticos bajo ventilación mecánica. Materiales y métodos: Cohorte retrospectiva de pacientes adultos consecutivos en ventilación mecánica, ingresados en la unidad de terapia intensiva de un hospital de tercer nivel en Cochabamba, Bolivia. Se incluyeron 161 pacientes sometidos a traqueostomía híbrida (dilatación única tipo Blue Rhino, cánula Portex y apoyo con pinza de Griggs), realizada de forma temprana o tardía según criterio del equipo tratante. Las variables principales fueron mortalidad intrahospitalaria, alta viva, DAOH a 28 y 60 días y complicaciones relacionadas con la traqueostomía. Resultados: La traqueostomía temprana se asoció con mayor incidencia acumulada de alta viva (subhazard ratio [sHR] 1,25; IC95% 1,01-1,55) y con incremento del riesgo de muerte intrahospitalaria (sHR 1,35; IC95% 1,02-1,80). Tasa de complicaciones baja. Los DAOH a 28 y 60 días fueron superiores en el grupo temprano (DAOH-60: 15,8 vs. 8,1 días). Discusión: La traqueostomía híbrida temprana se asocia con una resolución más rápida del episodio hospitalario y más DAOH. Conclusión: El aumento de mortalidad podría reflejar sesgo de indicación en pacientes más graves. Las decisiones sobre el momento óptimo deben individualizarse.
Citas
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. https://doi.org/10.1136/bmj.38467.485671.E0
Heffner JE. Timing of tracheotomy in mechanically ventilated patients. Am Rev Respir Dis. 1993;147(3):768-771. https://doi.org/10.1164/ajrccm/147.3.768
Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87(6):715-719. https://doi.org/10.1378/chest.87.6.715
Ciaglia P, Graniero KD. Percutaneous dilatational tracheostomy. Results and long-term follow-up. Chest. 1992;101(2):464-467. https://doi.org/10.1378/chest.101.2.464
Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med. 1999;27(8):1617-1625. https://doi.org/10.1097/00003246-199908000-00041
Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10(2): R55. https://doi.org/10.1186/cc4887
Putensen C, Theuerkauf N, Guenther U, Vargas M, Pelosi P. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care. 2014;18(6):544. https://doi.org/10.1186/s13054-014-0544-7
Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000;118(5):1412-1418. https://doi.org/10.1378/chest.118.5.1412
Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2015;2015(1):CD007271. https://doi.org/10.1002/14651858.CD007271.pub3
Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet. 1990;170(6):543-545. Disponible en: https://pubmed.ncbi.nlm.nih.gov/2343371/
Frova G, Quintel M. A new simple method for percutaneous tracheostomy: controlled rotating dilation. A preliminary report. Intensive Care Med. 2002;28(3):299-303. https://doi.org/10.1007/s00134-002-1218-5
Westphal K, Byhahn C, Wilke HJ, Lischke V. Percutaneous tracheostomy: a clinical comparison of dilatational (Ciaglia) and translaryngeal (Fantoni) techniques. Anesth Analg. 1999;89(4):938-943. https://doi.org/10.1097/00000539-199910000-00022
Divisi D, Altamura G, Battaglia C, Di Francescantonio W, Rosa E, Torresini G, De Sanctis C, Crisci R. La trachéotomie translaryngée selon la technique de Fantoni: à propos de 104 observations [Translaryngeal tracheostomy using the Fantoni technique: report of 104 cases]. Ann Chir. 2002;127(2):130-137. https://doi.org/10.1016/S0003-3944(01)00707-6
Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, Constantin JM, Demoule A, Diehl JL, Guinot PG, Jegoux F, L'Her E, Luyt CE, Mahjoub Y, Mayaux J, Quintard H, Ravat F, Vergez S, Amour J, Guillot M. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care. 2018;8(1):37. https://doi.org/10.1186/s13613-018-0381-y
Angel L, Kon ZN, Chang SH, Rafeq S, Palasamudram Shekar S, Mitzman B, Amoroso N, Goldenberg R, Sureau K, Smith DE, Cerfolio RJ. Novel percutaneous tracheostomy for critically ill patients with COVID-19. Ann Thorac Surg. 2020;110(3):1006-1011. https://doi.org/10.1016/j.athoracsur.2020.04.010
Long SM, Chern A, Feit NZ, Chung S, Ramaswamy AT, Li C, Cooley V, Hill S, Rajwani K, Villena-Vargas J, Schenck E, Stiles B, Tassler AB. Percutaneous and open tracheostomy in patients with COVID-19: comparison and outcomes of an institutional series in New York City. Ann Surg. 2021;273(3):403-409. https://doi.org/10.1097/SLA.0000000000004428
Serçe BC, Yurtlu DA, Tüzen AS, Şencan A, Çakirgöz M, Aksun M. Safety of percutaneous tracheostomy in critically ill COVID-19 patients: a retrospective observational study. Medicine (Baltimore). 2025;104(42):e45307. https://doi.org/10.1097/MD.0000000000045307
Takhar A, Tornari C, Amin N, Wyncoll D, Tricklebank S, Arora A, Ahmad I, Simo R, Surda P. Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation. J Laryngol Otol. 2020;134(11):992-997. https://doi.org/10.1017/S0022215120002303
Sasane SP, Telang MM, Alrais ZF, Shaikh WS, Alrais GZ, Khatib KI. Tracheostomy timing and outcomes in patients with coronavirus disease 2019-associated acute respiratory distress syndrome: a retrospective observational study. Int J Crit Illn Inj Sci. 2024;14(1):15-20. https://doi.org/10.4103/ijciis.ijciis_39_23
Nukiwa R, Uchiyama A, Tanaka A, Kitamura T, Sakaguchi R, Shimomura Y, Ishigaki S, Enokidani Y, Yamashita T, Koyama Y, Yoshida T, Tokuhira N, Iguchi N, Shintani Y, Miyagawa S, Fujino Y. Timing of tracheostomy and patient outcomes in critically ill patients requiring extracorporeal membrane oxygenation: a single-center retrospective observational study. J Intensive Care. 2022;10(1):56. https://doi.org/10.1186/s40560-022-00649-w
Khammas AH, Dawood MR. Timing of tracheostomy in intensive care unit patients. Int Arch Otorhinolaryngol. 2018;22(4):437-442. https://doi.org/10.1055/s-0038-1654710
Abe T, Madotto F, Pham T, Nagata I, Uchida M, Tamiya N, Kurahashi K, Bellani G, Laffey JG; LUNG-SAFE Investigators and the ESICM Trials Group. Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries. Crit Care. 2018;22(1):195. https://doi.org/10.1186/s13054-018-2126-6
Durbin CG Jr. Tracheostomy: why, when, and how? Respir Care. 2010;55(8):1056-1068. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20667153/
Myles PS, Shulman MA, Heritier S, Wallace S, McIlroy DR, McCluskey S, Sillar I, Forbes A. Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia. BMJ Open. 2017;7(8):e015828. https://doi.org/10.1136/bmjopen-2017-015828
Jerath A, Austin PC, Wijeysundera DN. Days alive and out of hospital: validation of a patient-centered outcome for perioperative medicine. Anesthesiology. 2019;131(1):84-93. https://doi.org/10.1097/ALN.0000000000002701
Ortega-Martinez RA, Ramos Zenteno RM, Garcés Hazou CL, Pardo Ledezma A, Cuadros Pariente NA, Orozco Crespo JC. Hybrid percutaneous tracheostomy in critically ill patients: dataset. Mendeley Data. 2025. https://doi.org/10.5281/zenodo.18864877
Kluge S, Baumann HJ, Maier C, Klose H, Meyer A, Nierhaus A, Kreymann G. Tracheostomy in the intensive care unit: a nationwide survey. Anesth Analg. 2008;107(5):1639-1643. https://doi.org/10.1213/ane.0b013e318188b818
Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275(3):679-690. https://doi.org/10.1007/s00405-017-4838-7
Szafran A, Dahms K, Ansems K, Skoetz N, Monsef I, Breuer T, Benstoem C. Early versus late tracheostomy in critically ill COVID-19 patients. Cochrane Database Syst Rev. 2023;11(11):CD015532. https://doi.org/10.1002/14651858.CD015532
Flaatten H, Gjerde S, Heimdal JH, Aardal S. The effect of tracheostomy on outcome in intensive care unit patients. Acta Anaesthesiol Scand. 2006;50(1):92-98. https://doi.org/10.1111/j.1399-6576.2005.00898.x
Combes A, Luyt CE, Nieszkowska A, Trouillet JL, Gibert C, Chastre J. Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Crit Care Med. 2007;35(3):802-807. https://doi.org/10.1097/01.CCM.0000256721.60517.B1
Clec'h C, Alberti C, Vincent F, Garrouste-Orgeas M, de Lassence A, Toledano D, Azoulay E, Adrie C, Jamali S, Zaccaria I, Cohen Y, Timsit JF. Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis. Crit Care Med. 2007;35(1):132-138. https://doi.org/10.1097/01.CCM.0000251134.96055.A6
Rossi V, Binda F, Cordani C, Marelli F, Tammaro S, Colombo S, Fantini A, Carlucci A, Grasselli G. Impact of tracheostomy on ICU stay in adult patients with ARDS: a systematic review. Intensive Crit Care Nurs. 2025;89:104076. https://doi.org/10.1016/j.iccn.2025.104076
Young D, Harrison DA, Cuthbertson BH, Rowan K; TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013;309(20):2121-2129. https://doi.org/10.1001/jama.2013.5154
Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Miletto A, Mangione S, Sinardi AU, Pastorelli M, Vivaldi N, Pasetto A, Della Rocca G, Urbino R, Filippini C, Pagano E, Evangelista A, Ciccone G, Mascia L, Ranieri VM. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-1489. https://doi.org/10.1001/jama.2010.447
Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. 2015;19:424. https://doi.org/10.1186/s13054-015-1138-8
Bösel J. Tracheostomy in stroke patients. Curr Treat Options Neurol. 2014;16(1):274. https://doi.org/10.1007/s11940-013-0274-1
Terragni P, Faggiano C, Martin EL, Ranieri VM. Tracheostomy in mechanical ventilation. Semin Respir Crit Care Med. 2014;35(4):482-491. https://doi.org/10.1055/s-0034-1383862
Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL; FEPIMCTI and LACCTIN. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care. 2017;38:304-318. https://doi.org/10.1016/j.jcrc.2016.10.009
Lau B, Cole SR, Gange SJ. Competing risk regression models for epidemiologic data. Am J Epidemiol. 2009;170(2):244-256. https://doi.org/10.1093/aje/kwp107
Shahidi N, Mahmoudpour A, Shahidi M, Shahmohammadi H. Association between tracheostomy timing and clinical outcomes in critically ill COVID-19 patients. Iran J Otorhinolaryngol. 2025;37(6):311-319. https://doi.org/10.22038/ijorl.2025.86206.3941
Descargas
Archivos adicionales
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Multidisciplinary & Health Education Journal
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
