PURPOSE: Tracheostomy is a commonly performed procedure in critically ill patients requiring prolonged ventilatory support. The objective of this study was to evaluate outcome differences between different sub-populations of critically ill patients who received an early or late tracheostomy.
METHODS: All critically ill patients who received a tracheostomy and were enrolled in Cooper Hospital's Project Impact database were included in the study. Patients were divided into two groups: Early (7 days or less after endotracheal intubation) and Late (8 days or greater). The patients were then subdivided based on principal admitting diagnosis: Post-Operative (PO), Head Trauma (HT), Multisystem Trauma (MT), Sepsis, Respiratory Distress (RD) and Medical/Non-Surgical Disease (MND). Comparative analysis was performed.
RESULTS: We identified 1202 patients who received tracheostomies (347 early, 855 late). The Early group was comprised of: 1 PO, 62 HT, 29 MT, 15 Sepsis, 75 RD, 165 MND. The Late group consisted of: 25 PO, 89 HT, 95 MT, 113 Sepsis, 163 RD, 370 MND. Mortality was found to be lower in the MND patients that received early tracheosotmies (p<0.001). Early and late tracheostomy did not influence functional status at discharge or discharge to a chronic ventilator facility in any group. Late tracheostomy was associated with more instances of ventilator assisted pneumonia in the RD (p=0.023) and MND (p=0.001) patients. All patients who underwent early tracheostomy had fewer ventilator days (p<0.001) and shorter length of stay (LOS) in the ICU (p<0.001). Hospital LOS was shorter in patients who received early tracheostomy in the Sepsis, RD and MND groups (p=0.01). Complication rates were significantly higher in patients who received late tracheostomy in the Sepsis (p=0.04) and MND group (p=0.04).
CONCLUSION: Early tracheostomy was associated with fewer days of mechanical ventilation, shorter LOS in the ICU and hospital and is more beneficial overall in Septic, MND, and RD patients.
CLINICAL IMPLICATIONS: Future prospective studies evaluating timing of tracheostomy should account for individual subpopulations of critically ill patients.
DISCLOSURE: Talia Ben-Jacob, No Financial Disclosure Information; No Product/Research Disclosure Information