Early or late tracheotomy in patients after polytrauma

Abstract

Introduction: Prolonged mechanical ventilation in patients after multi-organ trauma is an indication for tracheotomy, as well as to ensure proper toilet of the patient's respiratory tract. Recommendations determining the optimal time for the procedure remain ambiguous. Performing the procedure before the 10th day after intubation is beneficial for the therapy and the patient's health. Aim: The main objective of the study was to analyze the relationship between the timing of tracheotomy and the duration of mechanical ventilation in patients with multiple trauma. The secondary objective was to evaluate the relationship between the timing of the tracheotomy, and the length of stay in the ICU, total length of hospitalization and the incidence of pneumonia and mortality. Material and methods: A retrospective analysis of 124 patients of the Clinical Intensive Care Unit of the Military Institute of Medicine in Warsaw, Poland, who underwent tracheotomy in the years 2015-2019. The patients were divided into 2 groups: (1) patients who underwent the “early tracheotomy” (before day 10 of hospitalization) and (2) patients who underwent “late tracheotomy” (on the 10th day or later) Results: In patients who underwent tracheotomy before the 10th day of hospitalization, the use of mechanical ventilation was shorter (on average by 20.3 days). The duration of stay in the Intensive Care Unit (on average by 39.4 days) and the total time of hospitalization (on average by 43.1 days) were also significantly shorter. The mortality rate among patients with early tracheotomy was lower (2%) compared to patients with late tracheotomy (9%). Complication in the form of pneumonia was more common in patients with tracheotomy performed on day 10 or later. Conclusions: Tracheotomy performed up to the 10th day of hospitalization significantly reduces the duration of mechanical ventilation, the patient's stay in the intensive care unit and the total hospitalization time, and reduces the risk of pneumonia. There is no correlation between the timing of the tracheotomy performed and mortality.