الفهرس 
Introduction
Mechanical ventilationOnly 14 pages are availabe for public view
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Abstract
This study was conducted in Anesthesia ICUs in Assiut University Hospital in the period between the 1st of June 2015 and 31st of May 2016. It was conducted to identify the factors affecting the outcomes of tracheostomy done in ICU for patients subjected to prolonged intubation and ventilation and to suggest guidelines to control (a) proper timing of tracheostomy (b) process of decannulation. Out of 237 patients subjected to intubation and mechanical ventilation in anesthesia ICUs, 82 patients were included in this study. Sixty eight patients (82.9%) were males and 14 patients (17.1%) were females. Their mean age was 24 years. Most of the patients (84.2%) were less than 41 years. Trauma was the main cause of admission to ICUs as it represented (93.8%) of the causes of admission in ICUs. Road traffic accidents were the main cause of trauma and admission in 74% of trauma patients in ICUs. Most of the studied patients (92.8%) were intubated for duration less than two weeks. The mean duration of endotracheal intubation of the studied patients before performing tracheostomy was nine days. Most of the patients (97.5%) were operated upon during the period of admission in ICUs without the need for transfer to theater, while two patients (2.5%) were operated upon after discharge from ICUs in the operation rooms of otolaryngology department. Only one patient (1.2%) died due to tracheostomy tube obstruction. After exclusion of this patient, deacannulation was done successfully in (52/81) patients (64.2%), while failure of decannulation was recorded in (29/81) patients (35.8%).
By comparing the two groups; group of successful decannulation and group of failure of decannulation; there was statistically significant difference between the two groups regarding duration of intubation before tracheostomy and total duration of mechanical ventilation.
There was no statistically significant difference between the two groups regarding age, sex, diagnosis of admission, size of the endotracheal tubes, stomal infection and duration of ventilation through tracheostomy tubes.
Successful decannulation was achieved in the 1st trial in (45/52) patients (86.5%). Bronchoscopy has prominent role in decannulation. It helped in decannulation process of the seven patients. The mean duration of application of tracheostomy tubes (cannulation time) before successful decannulation was 49 days. Patients with poor neurological status (vegetative) with low GCS below eight represented 55.2% (16/29) of the causes of failure, while tracheal stenosis represented 44.8% (13/29). All the patients with tracheal stenosis were intubated for duration more than five days.