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 h 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 7 days 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: All patients underwent surgical tracheostomy. Majority 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 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).
CONCLUSIONS: 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 were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.
METHODS: In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h 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 7 days 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: All patients underwent surgical tracheostomy. Majority 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 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).
CONCLUSIONS: 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 were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.
摘要：
背景：气管造口术是一种挽救生命的手术，其结果可能因医院现有专业知识的差异而有所不同。我们的目标是建立适应症，乌干达早期气管造口术相关并发症及其相关因素。
方法：在一项前瞻性队列研究中，我们连续招募了一百名患者，成人和儿童气管造口术后2小时。在基线,关于患者的社会人口统计学信息，气管造口术的适应症,术前和术后特征是通过研究人员管理的问卷和医疗记录收集的。在基线时进行临床检查，但也在第7天或在7天随访期间怀疑气管造口术相关并发症时进行。患者基线特征的比较，使用Pearson卡方对两家医院的气管切开术的适应症和并发症进行了检查。对于早期气管造口术并发症的预测因子，在STATA13.0软件中使用二项回归拟合双变量和多变量分析模型.
结果：所有患者均接受外科气管切开术。大多数是成年人（84％）和男性（70％）。最常见的气管造口术指征是；肺厕所（58％）和预期的长时间插管（42％）。总的来说,53%（95%CI：43.0-62.7）有早期并发症，最常见的是管阻塞（52.6%）。早期气管造口术相关并发症的独立预测因素是：预期延长插管作为指征（RR=1.8，95CI：1.19-2.76），Bjork皮瓣气管切开（RR=1.6，95CI：1.09-2.43），垂直气管切口（RR=1.53，95CI：1.02-2.27），年龄在18岁以下（RR=1.22，95CI：1.00-1.47）。
结论：肺厕所是乌干达主要医院最常见的气管造口术指征。早期气管切开并发症的发生率很高，主要与术后气管切开管的管理有关。预期长时间插管作为气管造口术的指征，Bjork皮瓣或垂直气管切口以及儿童与并发症风险增加相关。强调多学科团队护理，气管造口术护理方案的标准化，并持续收集患者数据，并关注患者的生活质量因素，如早期恢复口服喂养，在资源不足的情况下，步行和正常言语可能具有改善气管造口护理质量的巨大潜力。
方法：在一项前瞻性队列研究中，我们连续招募了一百名患者，成人和儿童气管造口术后2小时。在基线,关于患者的社会人口统计学信息，气管造口术的适应症,术前和术后特征是通过研究人员管理的问卷和医疗记录收集的。在基线时进行临床检查，但也在第7天或在7天随访期间怀疑气管造口术相关并发症时进行。患者基线特征的比较，使用Pearson卡方对两家医院的气管切开术的适应症和并发症进行了检查。对于早期气管造口术并发症的预测因子，在STATA13.0软件中使用二项回归拟合双变量和多变量分析模型.
结果：所有患者均接受外科气管切开术。大多数是成年人（84％）和男性（70％）。最常见的气管造口术指征是；肺厕所（58％）和预期的长时间插管（42％）。总的来说,53%（95%CI：43.0-62.7）有早期并发症，最常见的是管阻塞（52.6%）。早期气管造口术相关并发症的独立预测因素是：预期延长插管作为指征（RR=1.8，95CI：1.19-2.76），Bjork皮瓣气管切开（RR=1.6，95CI：1.09-2.43），垂直气管切口（RR=1.53，95CI：1.02-2.27），年龄在18岁以下（RR=1.22，95CI：1.00-1.47）。
结论：肺厕所是乌干达主要医院最常见的气管造口术指征。早期气管切开并发症的发生率很高，主要与术后气管切开管的管理有关。预期长时间插管作为气管造口术的指征，Bjork皮瓣或垂直气管切口以及儿童与并发症风险增加相关。强调多学科团队护理，气管造口术护理方案的标准化，并持续收集患者数据，并关注患者的生活质量因素，如早期恢复口服喂养，在资源不足的情况下，步行和正常言语可能具有改善气管造口护理质量的巨大潜力。
