Tracheostomy care and outcomes in a tertiary care hospital in Sikkim- An observational study

Background: Tracheostomy is life saving in patients with neurological deficits, coma or facial trauma as it provides access for clearing the retained secretions and facilitates prolonged mechanical ventilation (MV). Patients with catastrophic neurologic insults, severe trauma or secondary respiratory failure had difficulty in weaning off a ventilator as well as delayed decanulation. Aim of the Study: To study the incidence and types of complications of Tracheostomy in a tertiary care Hospital setup in Sikkim with an objective to analyze the impact of socio-demographic profile of patient and co-morbidities on the successful decannulation in a tracheostomized patient. Materials: 51 patients on Mechanical Ventilation, requiring Tracheostomy for different indications at CRH, SMIMS, Tadong, Gangtok, Sikkim were analyzed. Demographic data and clinical finding were analysed. The effect of co-morbidities, duration of mechanical ventilation on the complications, and successful decanulation and the final outcomes were analyzed. Results: Among the 51 patients 49.01% were aged between 51 and 70 years. 70.58% were males and 129.41% were females with a male to female ratio of 2.4:1. Emergency Tracheostomy was done in 19.60% and on Elective basis in 80.39%. The correlation between length of the ICU stay and early & late Tracheostomy performed was significant (r-0.613, p-0.000). Association between co-morbidities and delayed decannulation was not significant (p-0.167). Conclusions: Tracheostomy on patients with prolonged mechanical ventilation was more commonly elective. The commonest indication for prolonged mechanical ventilation was trauma & intracranial tumours. The most common complications encountered were intra-operative haemorrhage, early postoperative complication was subcutaneous emphysema & late complication was stomal granulation tissue.