Tracheostomy for long-term ventilated patients:: a postal survey of ICU practice in The Netherlands

Objective: To assess the frequency, timing, technique, and follow-up of tracheostomy for long-term ventilated patients in different intensive care units (ICUs) in The Netherlands. Design and setting: Postal questionnaire, survey on retrospective data. A questionnaire was sent to all (n=63) ICUs with six or more beds suitable for mechanical ventilation and officially recognized by The Netherlands Intensive Care Society. Pediatric ICUs were excluded. Measurements and results: There was an 87% (n=55) response rate of contacted ICUs. The number of tracheostomies per year per unit varied widely (range 1-75), most ICUs (42%) performing between 11 and 25 tracheostomies per year. In 44% of ICUs (n=24) tracheostomy was not performed on a routine basis. In 25% of ICUs (n=14) tracheostomies were performed during the second week of ventilation. Surgical tracheostomy and percutaneous procedures were technique of first choice in 38% and 62% of ICUs, respectively. In only 7% of units were late follow-up protocols in use. Thirtytwo units (58%) reported a total of 56 major complications. Conclusions: Timing and technique of tracheostomy varies widely in Dutch ICUs. The percutaneous technique is the procedure of choice for tracheostomy in most of these units. Late follow-up protocols are rarely in use.