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Is Tracheostomy Safe?: Common Indications and Early Complications Among Ugandan Patients In A Pre-Covid-19 Era. (preprint)
researchsquare; 2021.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-963625.v1
ABSTRACT

Background:

Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda.

Methods:

In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 hours post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software.

Results:

Majority of patients were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated having prolonged intubation as an indication (RR=1.8, 95%CI 1.19 – 2.76), Bjork flap tracheal incision (RR=1.6, 95%CI 1.09 – 2.43), vertical tracheal incision (RR=1.53, 95%CI 1.02 – 2.27), and age below 18 years (RR=1.22, 95%CI 1.00 – 1.47).

Conclusion:

Within a pre-COVID-19 context, pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child increases the risk of complications. Emphasis on surgical training and post-procedural management for both clinicians and nurses should be made. New data will be needed within the COVID-19 era.
Subject(s)

Full text: Available Collection: Preprints Database: PREPRINT-RESEARCHSQUARE Main subject: COVID-19 / Neural Tube Defects Language: English Year: 2021 Document Type: Preprint

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Full text: Available Collection: Preprints Database: PREPRINT-RESEARCHSQUARE Main subject: COVID-19 / Neural Tube Defects Language: English Year: 2021 Document Type: Preprint