The Impact of Tracheostomy Timing on the Duration and Complications of Mechanical Ventilation

Abstract

Background: Mechanical ventilation is a life support for ICU patients and is indicated in case of acute or chronic respiratory failure. 75% of patients admitted to ICU require this support and most of them stay on prolonged MV. Tracheostomy plays a fundamental role in airway management, facilitating ventilator weaning and reducing the duration of MV. Early tracheostomy is defined when the procedure is conducted up to 10 days after the beginning of MV and late tracheostomy when the procedure is performed after this period. Controversy still exists over the ideal timing and classification of early and late tracheostomy. Objective: Evaluate the impact of timing of tracheostomy on ventilator weaning. Method: Single-center retrospective study. Patients were divided into three groups: very early tracheostomy (VETrach), intermediate (ITrach) and late (LTrach): >10 days. Results: One hundred two patients were included: VETrach (n=21), ITrach (n=15), and LTrach (n=66). ITrach group had lower APACHE II (p=0.004) and SOFA (p≤0.001). Total ICU length of stay, and incidence of post-tracheostomy ventilator-associated pneumonia were significantly lower in the VETrach and ITrach groups. The GCS and RASS scores improved in all groups, while the maximal inspiratory pressure and rapid shallow breathing index showed a tendency towards improvement on discharge from the ICU. Conclusion: Very early tracheostomy did not reduce the duration of MV or length of ICU stay after the procedure when compared to late tracheostomy, but was associated with low rates of ventilatorassociated pneumonia. Neurological patients benefitted more from tracheostomy, particularly very early and intermediate tracheostomy.