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

Jean Louis Trouillet 1, 2 Olivier Collange 3 Fouad Belafia 4 Francois Blot 5 Gilles Capellier 6, 7 Eric Cesareo Jean-Michel Constantin 8 Alexandre Demoule 1 Jean-Luc Diehl 9, 10 Pierre-Gregoire Guinot 11 Franck Jegoux 12 Erwan l'Her 13 Charles-Edouard Luyt 14, 1 Yazine Mahjoub 15, 16 Julien Mayaux 1 Herve Quintard 17 Francois Ravat Sebastien Vergez 18 Julien Amour 19 Max Guillot 20, 21, 22
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.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03575452
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Soumis le : mardi 15 février 2022 - 15:12:51
Dernière modification le : dimanche 1 mai 2022 - 03:16:16

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Jean Louis Trouillet, Olivier Collange, Fouad Belafia, Francois Blot, Gilles Capellier, et al.. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Annals of intensive care, 2018, 8, ⟨10.1186/s13613-018-0381-y⟩. ⟨hal-03575452⟩

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