Precocious tracheotomy versus prolonged intubation in a medical ICU

Introduction

The main purpose of our study was to assess whether precocious tracheotomy, compared with prolonged intubation, reduces the duration of ventilation, the frequency of nosocomial pneumopathy, the duration of hospitalization and the mortality.

Methods

A retrospective and comparative study between two groups who present a neurologic or respiratory pathology and require mechanical ventilation for more than 3 weeks. The study covered 7 years and was about 60 patients divided into two groups: tracheotomy group (TG, n = 30), where the tracheotomy was realized between the eighth day and the 15th day, after the first period of intubation; and intubation group (IG, n = 30), where the patients are still intubated during the whole period of hospitalization until extubation or death. We determined the duration of ventilation, the frequency of nosocomial pneumopathy, the mean duration of hospitalization and the mortality. The statistical study was based on the chi-squared test for qualitative variables and on Student's test for quantitative variables. P < 0.05 was considered significant. The two groups contain a similar number of cases that have the same diagnosis. They have the same data about age, the sex and the gravity score: SAPS II and APACHE II score.

Results

There was a significant statistical decrease of the whole duration of mechanical ventilation for the TG, 27.03 ± 3.31 days versus 31.63 ± 6.05 days for the IG, with P = 0.001. However, there was no significant difference between the two groups for the frequency of nosocomial pneumopathy (P = 0.18). The mean duration of hospitalization did not differ between the two groups, and was about 30.96 ± 9.47 days for the TG versus 34.26 ± 9.74 days for the IG with P = 0.10. The study of the evolution shows that there was no statistically significant difference between the two groups regarding the mortality, 26.7% in the TG versus 46.7% for the IG with P = 0.10.

Conclusion

It seems that precocious tracheotomy in the resuscitation of patients leads to a decrease of the duration of ventilation and delayed the incidence of nosocomial pneumopathy without a modification of the frequency of the mean duration of hospitalization in the resuscitation ward, or of death.