Tracheostomy Timing and Outcomes in the Critically Ill

Abstract

Objective: Although data supports the use of tracheostomy in trauma patients admitted to intensive care units (ICUs), optimal timing of tracheostomy in nontrauma patients remains controversial. The purpose of this study is to examine the impact of early tracheostomy on duration of ICU and overall hospital stay in unselected ICU patients. Method: The following data were collected from records of adult patients (n = 1097) who underwent tracheostomy from 2005 to 2010: demographics, survival, duration of oral intubation, mechanical ventilation (MV), ICU stay, overall hospital stay, and incidence of ventilator-associated pneumonia (VAP). Tracheostomy was considered early if it was performed by day 7 of MV. Results: Of the 114 unselected ICU patients who underwent tracheostomies with preliminary data available, 26 were early and 88 were late. Differences between age, sex, and survival were not statistically significant. Duration of MV, ICU stay, and overall hospital stay were significantly shorter in the early tracheostomy group (mean ± standard error: 16.54 ± 2.54 days vs 31.18 ± 1.83 days). Conclusion: Early tracheostomy in unselected ICU patients is associated with early movement from the ICU, shorter duration of mechanical ventilation, and shorter length of overall hospital stay without affecting mortality. Development of clinical guidelines that describe the criteria for early tracheostomy of non-trauma patients is warranted.