PURPOSE: Timing of tracheostomy in critically ill patients is controversial. In the neurology and neurosurgery patients subgroup the data regarding optimal time of tracheostomy and the effects of this in the length of stay (LOS) in the intensive care unit (ICU) is scarce. We hypothesized that early tracheostomy will reduce the LOS in ICU and result in faster weaning from mechanical ventilation.
METHODS: Retrospective chart review of patients admitted to neuro-ICU with a primary neurological or neurosurgical diagnosis and had a tracheostomy done from July 1st 2005 to June 30th 2006. Patients that were made comfort care measures and care was withdrawn were excluded. For each eligible patient data was collected on date of ICU admission, primary admission diagnosis, co morbidities, date of tracheostomy, time to wean from mechanical ventilation, time to leave the ICU, complications during ICU stay and disposition. Primary outcome was LOS in ICU and secondary outcome was weaned or not from mechanical ventilation (MV) during ICU stay. Cox multivariate regression analysis was used to identify independent predictors of LOS in ICU. Multiple logistic regression was used to find if timing of tracheostomy influenced ventilator weaning.
RESULTS: 110 charts were reviewed, 31 patients were excluded, according to exclusion criteria above and 79 patients were eligible for the study. Early tracheostomy appeared to be a statistically significant predictor of decreased LOS in ICU with hazard ratio (HR) per day, HR=0.8 (p<0.0001). Time to tracheostomy and age were related to LOS in ICU, but the age factor disappeared when controlled for discharge to a ventilator facility. Time to tracheostomy did not influence disposition to a ventilator facility. Time to tracheostomy did not predict early weaning from MV.
CONCLUSION: This study suggests that early tracheostomy in critically ill neurology and neurosurgery patients results in decrease stay in ICU, but can not predict weaning from MV.
CLINICAL IMPLICATIONS: Early tracheostomy in this patient population by decreasing LOS in ICU can decrease hospital costs.
DISCLOSURE: Georgios Chrysochoou, No Financial Disclosure Information; No Product/Research Disclosure Information