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July 1987

Timing of Tracheotomy in the Long-term Intubated Patient: Complications and Attitudes of Health Care Professionals

Author Affiliations

Syracuse, NY

Arch Otolaryngol Head Neck Surg. 1987;113(7):703. doi:10.1001/archotol.1987.01860070017006

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Patients may well be suffering needlessly from prolonged intubation due to fears of tracheotomy among internists according to a recent report at the Eastern Section of the Triological Society. Citing a strong resistance to the use of tracheotomy by internists in New Haven (Conn) as a result of a paper by Stauffer and colleagues in 1981, suggesting a high complication rate (66%) with questionable benefit, Dr David Astrachan of Yale University (New Haven, Conn) decided to look critically at the advisability of tracheotomy. He looked prospectively at 52 patients, 46 of whom had been intubated for three weeks prior to tracheotomy, and found a 57% complication rate associated with the endotracheal tube as compared with a 14% complication rate in the tracheotomized patients. All tracheotomy complications were minor, including primarily stomal infections and minor bleeding.

Dr Astrachan and Dr Goodwin also surveyed 60 critical care nurses regarding the care, management,

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