"HYPER-EARLY" Tracheostomy within 48 hours has less Complications and Better Prognosis Compared to Traditional Tracheostomy.

Abstract

Tracheostomies may be performed "early" or "late." There is no agreement on the best timing for tracheostomy. This study compares tracheostomies and complications when performed within 48 hours with those performed from 48hours to 21days. Patients who underwent tracheostomy in the 2017-2018 National Trauma Data Bank (NTDB) were categorized into 2 groups: early tracheostomy (≤48hours) and late tracheostomy (>48hours to 21days). Primary outcome measured was mortality. Chi square models, Mann-Whitney U Test, and multivariate logistics were used for data analysis. 843 patients had tracheostomy performed, of which 16% underwent early tracheostomy. Majority were male in both early (84%) and late (74%) tracheostomy groups. Mortality was not statically significant in early (13%) or late (9%) (P = .151). Total duration of ventilation in early tracheostomy group was less (5days) compared to late tracheostomy group (16 days, P < .001). Patients with late tracheostomy had almost 18% cases of ventilator-associated pneumonia (VAP) when compared to early tracheostomy patients (7%, P < .001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20days) than late tracheostomy patients (P<.001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27 days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20days) than late tracheostomy patients (P < .001). Tracheostomy performed as early as 48hours is beneficial as it demonstrates a decrease time on ventilator, decreased HLOS, as well as lower VAP rates. Our data shows "hyper-early" tracheostomies might be more beneficial that the current national practice.