Early tracheotomy in elderly patients results in less ventilator-associated pneumonia

Abstract

Objectives: To determine if the timing of tracheotomy in elderly patients results in less ventilator associated-pneumonia, mortality, and morbidity.Study Design: Historical cohort study.Subjects and Methods: This study included 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographics, outcomes, and ventilation data were collected and analyzed.Results: The early tracheotomy group (continuous intubation time <7 days) included 43 patients, and 115 patients were included in the late group. There were no statistically significant differences in the demographics of the two groups. A statistically significant difference in the rate of ventilator-associated pneumonia was noted in the early versus late tracheotomy group (−0.29% VAP, 95% CI: −0.46, −0.12). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (0.70 intubations, 95% CI: 0.41, 0.99). The early tracheotomy group has a lower total ICU admission time (−9.5 days, 95% CI: −21.81, −2.25) and total hospital admission time (−10 days, 95% CI: −33.69, −2.249). There was no difference in mortality, although there was a trend of lower mortality in the early tracheotomy group (−11.3% mortality, 95% CI: −0.27, −0.05).Conclusion: Early tracheotomy in elderly patients is associated with less ventilator-associated pneumonia, more frequent intubations, less total admission time, and a trend toward lower mortality.