Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era


Background Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on dis parities 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 indica tions, 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 trache ostomy-related complication was suspected during the 7 days follow-up. Comparison of patients’ baseline charac teristics, 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 ftted using binomial regression in STATA 13.0 software. Results All patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The common est 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 pre dictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR=1.8, 95%CI: 1.19 – 2.76), Bjork fap 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 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 fap 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.



Tracheostomy, Indication, Incidence, Early complications, Pre-Covid-19