Timing of tracheostomy for prolonged mechanical ventilation in unselected critical ill patients

doi:10.3969/j.issn.1002-1949.2015.09.014

Abstract：Objective Tracheostomy is a common clinical practice in ICU , but less research was focused on the relationship between the timing of tracheostomy and outcome of severe ill patients in China.This study aims to examine the association between early tracheostomy and mortality in ICU from China.Methods This retrospective observational cohort study was performed at a tertiary -care, university – affiliated hospital .Unselected patients requiring mechanical ventilation for ≥48 hours enrolled from January 2010 to December 2013 .According to the frequency distribution were classified. Early tracheostomy( ET) is considered if the procedure occurred≤5 days after mechanical ventilation and tracheostomy was considered late ( LT ) if the procedure occurred >5 days after mechanical ventilation.Data were collected from electronic medical record by senior physicians .Results Of the 860 mechanical ventilation patients screened , 234 (27.21%) received a tracheostomy , and 159 patients received the tracheostomy in early group and 75 patients received of patients ’ illness between the two groups.No significant difference in illness severity were between two groups .Older patients less likely received early tracheostomy (P<0.01) while patients with brain injury or central neurological disease more likely received early tracheostomy (P<0.01).The decannulated rate on discharge was similar between two groups .All -cause mortality at ICU discharge was no significantly different between 20.09%in early group and 11.97% in late group (P=0.2344).Median critical care unit length of stay was decreased for 29 days in early group while 33 days in late group ( P =0.015).Median mechanical ventilation period was shorter in early group for 14.97 days than in late group for 20.69 days (P=0.013).Conclusion Tracheosotmy within 5 days of critical care admission is not associated with an improvement at ICU discharge , but may benefit from shorter mechanical ventilation period and associated LOS in ICU .