Outcome of tracheostomy timing on critically ill adult patients undergoing mechanical ventilation: a retrospective observational study

Introduction

Tracheostomy is now an established standard of care in the management of some critically ill patients. Despite this, however, the effect of its timing on patient outcome remains unclear [1].

Methods

We interrogated the database of our clinical information system (MetaVision, iMDSoft) and identified 75 patients who underwent tracheostomy insertion. Outcome data, including 28-day mortality, length of stay (LOS) and weaning interval, were captured for those patients undergoing tracheostomy <4 days into critical care admission (early group) and >4 days into critical care admission (late group). Continuous data when expressed as mean (SD) were analysed using t-test and when expressed as median (IQR) were analysed using the Mann-Whitney U test. Binary outcome data were analysed using the chi-square test. P < 0.05 was considered statistically significant.

Results

The early group (n = 32) had a mean LOS of 19 days (SD = 16.57), median weaning interval of 9 days (IQR = 9.5) and a mortality of 12.5% (n = 4). The late group (n = 43) had a mean LOS of 21.6 days (SD = 12.62), median weaning interval of 8 days (IQR = 13) and a mortality of 27.9% (n = 12). More tracheostomies were performed late at our institution, but despite this there was no significant difference in LOS (P = 0.481, t test), weaning interval (P = 0.852, Mann-Whitney U test) or 28-day mortality (P = 0.107, chi-square test) between the two groups.

Conclusions

Many clinicians believe that early tracheostomy insertion may benefit critically ill patients requiring mechanical ventilation. This benefit does not seem to extent to 28-day survival, critical care LOS or weaning from mechanical ventilation.