Early Tracheotomy in the Elderly Results in Less Pneumonia

Abstract

Objective To determine if early tracheotomy in elderly patients (age > 65) results in less ventilator associated pneumonia, mortality and morbidity. Methods This is a retrospective chart review of 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographic data, admission criteria, medical comorbidities, disposition, outcome, and ventilation data were collected and analyzed. Results 158 patients were included in the study. 43 patients were included in the early tracheotomy group (continuous intubation time <7 days), and 115 patients were included in the late tracheotomy group. There were no statistically significant differences in the demographics of the 2 groups including age, gender, race, reason for intubation (respiratory failure, airway obstruction, etc), or medical comorbidities including COPD. A highly statistically significant difference in the rate of ventilator associated pneumonia was noted in the early vs. late tracheotomy group (23.3% vs 52.6%, p<0.0009). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (2.2 vs 1.5, p<0.0001). The total admission time was also shorter in the early tracheotomy group (27.0 days vs 39.0 days, p<.0171). There was no difference noted in mortality, although there was a general trend of lower mortality in the early tracheotomy group (20.1% vs 32.1%, p<0.1683). Conclusions Early tracheotomy in elderly patients is associated with less ventilator associated pneumonia, more frequent intubations, less total admission time, and a trend towards lower mortality.