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Tracheotomy in the intensive care unit: Guidelines from a French expert panel

Jean-Louis Trouillet 1 Fouad Belafia 2 Francois Blot 3 Gilles Capellier 4, 5 Eric Cesareo Jean-Michel Constantin 6 Alexandre Demoule 7 Jean-Luc Diehl 8, 9 Pierre-Gregoire Guinot 10 Franck Jegoux 11 Erwan L'Her 12 Charles-Edouard Luyt 1, 7 Yazine Mahjoub 13, 14 Julien Mayaux 7 Herve Quintard 15 Francois Ravat Sebastien Vergez 16 Julien Amour 17 Max Quillot Olivier Collange 18 
Abstract : Tracheotomy is widely used in intensive care units, albeit with great disparities between medical teams in terms of frequency and modality. Indications and techniques are, however, associated with variable levels of evidence based on inhomogeneous or even contradictory literature. Our aim was to conduct a systematic analysis of the published data in order to provide guidelines. We present herein recommendations for the use of tracheotomy in adult critically ill patients developed using the grading of recommendations assessment, development and evaluation (GRADE) method. These guidelines were conducted by a group of experts from the French Intensive Care Society (Societe de reanimation de langue francaise) and the French Society of Anesthesia and Intensive Care Medicine (Societe francaise d'anesthesie reanimation) with the participation of the French Emergency Medicine Association (Societe francaise de medecine d'urgence), the French Society of Otorhinolaryngology. Sixteen experts and two coordinators agreed to consider questions concerning tracheotomy and its practical implementation. Five topics were defined: indications and contraindications for tracheotomy in intensive care, tracheotomy techniques in intensive care, modalities of tracheotomy in intensive care, management of patients undergoing tracheotomy in intensive care, and decannulation in intensive care. The summary made by the experts and the application of GRADE methodology led to the drawing up of 8 formal guidelines, 10 recommendations, and 3 treatment protocols. Among the 8 formal guidelines, 2 have a high level of proof (Grade 1 +/-) and 6 a low level of proof (Grade 2 +/-). For the 10 recommendations, GRADE methodology was not applicable and instead 10 expert opinions were produced. (C) 2018 The Author(s). Published by Elsevier Masson SAS on behalf of Societe francaise d'anesthesie et de reanimation (Sfar).
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Soumis le : mardi 15 février 2022 - 15:12:35
Dernière modification le : vendredi 9 septembre 2022 - 10:20:08

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Jean-Louis Trouillet, Fouad Belafia, Francois Blot, Gilles Capellier, Eric Cesareo, et al.. Tracheotomy in the intensive care unit: Guidelines from a French expert panel. Anaesthesia Critical Care & Pain Medicine, Elsevier Masson, 2018, 37 (3), pp.281-294. ⟨10.1016/j.accpm.2018.02.012⟩. ⟨hal-03575450⟩

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