Tracheotomy Timing and Outcomes in the Critically Ill

Abstract

Objective To examine the impact of early tracheotomy in nontrauma patients on duration of mechanical ventilation (MV), intensive care unit (ICU) stay, and overall hospital stay. Design Case series with chart review. Setting Tertiary care medical center. Methods A retrospective study was performed for patients undergoing tracheotomy from 2005 to 2010. Demographics; survival; duration of endotracheal intubation, MV, ICU, and overall hospital stay; and incidence of ventilator-associated pneumonia (VAP) were assessed. Tracheotomy was considered early if it was performed by day 7 of MV and late thereafter. Nonparametric statistics were used to compare results from each group. Results Of the 592 patients included in the analysis, 128 received tracheotomy early and 464 late. Differences between age, sex, and overall survival were not statistically significant. Duration of MV was 45% less (mean ± standard error: 21.47 ± 1.86 days vs 39.33 ± 1.33 days; P < .001), total ICU stay was shortened by 33% (17.52 ± 1.38 days vs 26.27 ± 0.73 days; P < .001), and length of overall hospital course was reduced by 34% (35.85 ± 2.57 days vs 54.28 ± 1.60 days; P < .001) in the early tracheotomy group. Three patients (2.3%) from the early tracheotomy group developed VAP as compared with 15 (3.2%) from the late group. Duration from tracheotomy to ICU transfer and 30% overall mortality did not differ significantly between groups. Conclusion Early tracheotomy in ICU patients is associated with earlier ICU discharge, shorter duration of mechanical ventilation, and decreased length of overall hospital stay without affecting mortality.