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Early Versus Late Tracheostomy in Critically Ill Patients FREE TO VIEW

Omolola Adesina, MD; Shadi Soufi, MD; Mariam Alhamad, BS; Gabrielle Walsmann, MD; Muhammad Shibli, MD
Chest. 2011;140(4_MeetingAbstracts):189A. doi:10.1378/chest.1116744
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PURPOSE: The Study was conducted to determine if early tracheostomy (ET) had any impact on the outcome of patients requiring prolonged mechanical ventilation, in terms of hospital and ICU length of stay (LOS) and hospital mortality.

METHODS: Retrospective chart review of randomly selected 196 critically ill Medical/surgical ICU patients over three years period. All patients on mechanical ventilation in the ICU requiring tracheostomy after admission. Excluded patients were those with tracheostomy prior to admission and emergent tracheostomy for airway maintenance.Charts reviewed for demographics admission diagnoses,co-morbidities,length of stay in ICU,number of days on ventilator,hospital length of stay,mental status and final outcome.Patients were divided into two groups:early tracheostomy(ET)occurring within 15 days of mechanical ventilation and late tracheostomy(LT)after 15 days of mechanical ventilation.The two groups were compared in terms of length of stay,number of ventilator dependent days,degree of mental status,final outcome(Death or transfer to a long-term care facility).

RESULTS: 196 patients had tracheostomy over three years period.Average age 67 years.Male:Female ratio was 1:1. 138(70%)had ET(early tracheostomy)and58(30%)had LT(Late tracheostomy).ET had mean ventilator days of 18 compared with 36 for LT (T=8.7,significant).Mean hospital LOS for ET was 25 versus 46 for LT(T=7.1,significant). The ICU-LOS was 15 for ET versus 27 for LT(T=9.2,significant).The mortality rate for ET was 16% versus 27% for LT(P>0.05).The degree of mental status(awake,drowsy,lethargic,or comatose)did not affect the timing of tracheostomy(P>0.05).

CONCLUSIONS: Early tracheostomy comapred to late tracheostomy reduces the days on mechanical ventilation,reduces the hospital & ICU length of stay, but it does not affect the hospital mortality rate.

CLINICAL IMPLICATIONS: Early tracheostomy is beneficial to patients requiring prolonged mechanical ventilation by reducing the risk of some of the morbidity measures.

DISCLOSURE: The following authors have nothing to disclose: Omolola Adesina, Shadi Soufi, Mariam Alhamad, Gabrielle Walsmann, Muhammad Shibli

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