Association of Early Tracheostomy with Length of Stay and Mortality in Critically Ill Patients

Overview

Journal J Laryngol Otol

Publisher Cambridge University Press

Specialty Otorhinolaryngology

Date 2024 Apr 22

PMID 38644742

Authors

Aman M Patel

Rushi Patel

Lucy Revercomb

David Avery Cohen

Christopher C Tseng

Wayne D Hsueh

Andrey Filimonov

Affiliations

Soon will be listed here.

Abstract

Background: The timing of tracheostomy for intensive care unit patients is controversial, with conflicting findings on early versus late tracheostomy.

Methods: Patients undergoing tracheostomy from 2001through 2012 were identified from the Medical Information Mart for Intensive Care-III database. Early tracheostomy was defined as less than the 25th percentile of time from intensive care unit admission to tracheostomy (time to tracheostomy). Statistical analysis for tracheostomy timing on intensive care unit length of stay and mortality were conducted.

Results: Of the 1,566 patients that were included, patients with early tracheostomy had shorter intensive care unit length of stay (27.32 12.55 days, < 0.001) and lower mortality (12.9 per cent 9.0 per cent, = 0.039). Multivariate logistic regression analysis found an association between increasing time to tracheostomy and mortality (odds ratio: 1.029, 95 per cent confidence interval 1.007-1.051, = 0.009).

Conclusion: Our analysis revealed that patients with early tracheostomy were more likely to have shorter intensive care unit lengths of stay and lower mortality. Our data suggest that early tracheostomy should be given strong consideration in appropriately selected patients.

References

Nieszkowska A, Combes A, Luyt C, Ksibi H, Trouillet J, Gibert C . Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005; 33(11):2527-33. DOI: 10.1097/01.ccm.0000186898.58709.aa. View

Yavas S, Yagar S, Mavioglu L, Cetin E, Iscan H, Ulus A . Tracheostomy: how and when should it be done in cardiovascular surgery ICU?. J Card Surg. 2008; 24(1):11-8. DOI: 10.1111/j.1540-8191.2008.00695.x. View

Devarajan J, Vydyanathan A, Xu M, Murthy S, McCurry K, Sessler D . Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. J Am Coll Surg. 2012; 214(6):1008-16.e4. DOI: 10.1016/j.jamcollsurg.2012.03.005. View

Scales D, Thiruchelvam D, Kiss A, Redelmeier D . The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008; 36(9):2547-57. DOI: 10.1097/CCM.0b013e31818444a5. View

Moller M, Slaikeu J, Bonelli P, Davis A, Hoogeboom J, Bonnell B . Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg. 2005; 189(3):293-6. DOI: 10.1016/j.amjsurg.2005.01.002. View

Young D, Harrison D, Cuthbertson B, Rowan K . Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013; 309(20):2121-9. DOI: 10.1001/jama.2013.5154. View

Adly A, Youssef T, El-Begermy M, Younis H . Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2017; 275(3):679-690. DOI: 10.1007/s00405-017-4838-7. View

Koch T, Hecker B, Hecker A, Brenck F, Preuss M, Schmelzer T . Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbecks Arch Surg. 2012; 397(6):1001-8. DOI: 10.1007/s00423-011-0873-9. View

Rodriguez J, Steinberg S, Luchetti F, Gibbons K, Taheri P, Flint L . Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990; 108(4):655-9. View

10.

Liu C, Livingstone D, Dixon E, Dort J . Early versus late tracheostomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2014; 152(2):219-27. DOI: 10.1177/0194599814561606. View

11.

Hosokawa K, Nishimura M, Egi M, Vincent J . Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care. 2015; 19:424. PMC: 4669624. DOI: 10.1186/s13054-015-1138-8. View

12.

Hong S, Oh B, Kim Y, Kang E, Kim C, Park Y . Characteristics of mechanical ventilation employed in intensive care units: a multicenter survey of hospitals. J Korean Med Sci. 2009; 23(6):948-53. PMC: 2610657. DOI: 10.3346/jkms.2008.23.6.948. View

13.

Villwock J, Jones K . Outcomes of early versus late tracheostomy: 2008-2010. Laryngoscope. 2014; 124(8):1801-6. DOI: 10.1002/lary.24702. View

14.

Melsen W, Rovers M, Bonten M . Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med. 2009; 37(10):2709-18. DOI: 10.1097/ccm.0b013e3181ab8655. View

15.

Tong C, Kleinberger A, Paolino J, Altman K . Tracheotomy timing and outcomes in the critically ill. Otolaryngol Head Neck Surg. 2012; 147(1):44-51. DOI: 10.1177/0194599812440262. View

16.

Cai S, Hu J, Liu D, Bai X, Xie J, Chen J . The influence of tracheostomy timing on outcomes in trauma patients: A meta-analysis. Injury. 2017; 48(4):866-873. DOI: 10.1016/j.injury.2017.02.023. View

17.

Durbin Jr C . Indications for and timing of tracheostomy. Respir Care. 2005; 50(4):483-7. View

18.

Terragni P, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini F . Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010; 303(15):1483-9. DOI: 10.1001/jama.2010.447. View

19.

Scales D, Kahn J . Tracheostomy timing, enrollment and power in ICU clinical trials. Intensive Care Med. 2008; 34(10):1743-5. DOI: 10.1007/s00134-008-1194-5. View

20.

Plummer A, GRACEY D . Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989; 96(1):178-80. DOI: 10.1378/chest.96.1.178. View