The effect of timing of tracheostomy on clinical outcomes in patients with infratentorial lesions

Abstract

Objective To determine the effect of timing of tracheostomy on clinical outcome in neurosurgical patients with infratentorial lesions admitted to the intensive care unit (ICU). Methods A total of 253 neurosurgical patients with infratentorial lesions, who underwent tracheostomy at Department of Intensive Care Unit (ICU), Beijing Tiantan Hospital from January 2015 to December 2017, were enrolled into this study. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 7 days after operation in the early group (group E, n=128), whereas in the late group, it was performed after 7 days post operation (group L, n=125). Total duration of mechanical ventilation (MV), length of stay (LOS) at ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between the 2 groups. Results The total MV duration, ICU and hospital LOS were significantly longer in group L than in group E [M(P25, P75): 7 (3.0, 12.0) d vs. 0 (0, 5.8) d; 19 (15.0, 25.5) d vs. 9 (8.0, 12.0) d, 31 (27.0, 39.5) d vs. 20 (17.0, 24.0) d, respectively, all P<0.001]. The incidence of VAP was higher in group L than in group E [88.0%(110/125) vs. 30.5%(39/128), P<0.01]. Conclusion Early (within 7 days) tracheostomy could reduce the MV duration, ICU LOS and incidence of VAP in critically ill neurosurgical patients with infratentorial lesions. Key words: Infratentorial neoplasms; Intensive care units; Tracheotomy; Operation time; Prognosis