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OBJECTIVES: To compare the clinical outcomes of early versus late tracheostomy in patients who require prolonged mechanical ventilation. METHODS: A prospective observational study was done. The sample was a cohort of 90 patients who had tracheostomy in the medical intensive care unit of a university-affiliated teaching hospital. Primary outcome measures were duration of mechanical ventilation and total cost of hospitalization. Tracheostomy was defined as early if performed by day 10 of mechanical ventilation and late if performed thereafter. RESULTS: Fifty-three patients had early tracheostomy (mean +/- SD = day 5.9 +/- 7.2 of ventilation), and 37 patients had late tracheostomy (mean +/- SD = day 16.7 +/- 2.9) (P < .001). The mean (+/- SD) duration of mechanical ventilation was 28.3 +/- 28.2 days in the early-tracheostomy group versus 34.4 +/- 17.8 days in the late-tracheostomy group (P = .005). Total cost of hospitalization was significantly lower in the early-tracheostomy group (mean +/- SD = $86,189 +/- $53,570) than in the late-tracheostomy group (mean +/- SD = $124,649 +/- $54,282) (P = .001). Male sex (adjusted odds ratio = 3.84; 95% CI = 2.32-6.34; P = .007) and higher ratios of PaO2 to fraction of inspired oxygen (adjusted odds ratio = 1.01; 95% CI = 1.00-1.01; P = .03) were associated with early tracheostomy. The timing of tracheostomy was not associated with hospital mortality. CONCLUSION: Early tracheostomy is associated with shorter lengths of stay and lower hospital costs than is late tracheostomy among patients in the medical intensive care unit. Prospective clinical trials are necessary to determine the optimal timing of tracheostomy in that setting.

Context With the rise of the Delta variant of SARS-CoV-2 and the low vaccination rates in the United States, mitigation strategies to reduce the spread of SARS-CoV-2 are essential for protecting the health of the general public and reducing strain on healthcare facilities. This study compares US counties with and without mask mandates and determines if the mandates are associated with reduced daily COVID-19 infection. US counties have debated whether masks effectively decrease COVID-19 cases, and political pressures have prevented some counties from passing mask mandates. This article investigates the utility of mask mandates in small US counties. Objectives This study aims to analyze the effectiveness of mask mandates in small US counties and places where the population density may not be as high as in larger urban counties and to determine the efficacy of countywide mask mandates in reducing daily COVID-19 infection. Methods The counties studied were those with populations between 40,000 and 105,000 in states that did not have statewide mask mandates. A total of 38 counties were utilized in the study, half with and half without mask mandates. Test counties were followed for 30 days after implementing their mask mandate, and daily new SARS-CoV-2 infection was recorded during this timeframe. The counties were in four randomly selected states that did not have statewide mask mandates. The controls utilized were from counties with similar populations to the test counties and were within the same state as the test county. Controls were followed for the same 30 days as their respective test county. Data were analyzed utilizing t-test and difference-in-difference analyses comparing counties with mask mandates and those without. Results These data showed statistically significant lower averages of SARS-CoV-2 daily infection in counties that passed mask mandates when compared with counties that did not. The difference-in-difference analysis revealed a 16.9% reduction in predicted COVID-19 cases at the end of 30 days. Conclusions These data support the effectiveness of mask mandates in reducing SARS-CoV-2 infection spread in small US counties where the population density may be less than in urban counties. Small US counties that are considering passing mask mandates for the population can utilize these data to justify their policy considerations.

The complexity of patients cared for in modern ICUs, along with continuing advances in the technology of critical care and the escalating costs associated with providing that care, have been motivating factors for critical care practitioner to identify and implement “best” medical practices. Individual best practices are often determined based on their association with improvements in patient outcomes, increased efficiency and cost‐effectiveness of medical care, or both. These practices should ideally be determined based on sound medical evidence obtained from rigorously performed clinical trials, the most rigorous being randomized controlled trials. However, such trials have often not been performed for many aspects of critical care medicine. Outcomes research is an emerging field which attempts, in part, to use variations in medical practices, as well as formal scientific investigations, to identify important associations between specific medical practices and clinical outcomes. This review focuses on two areas of mechanical ventilation, acute respiratory distress syndrome (ARDS) and weaning, to illustrate how outcomes research can be employed to facilitate decision making in the management of patients with respiratory failure.

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Brook AD, Kollef MH An outcomes-based approach to ventilatory management review of two examples J Intensive Care Med 1999,14 262-274The complexity of patients cared for in modern ICUs, along with continuing advances in the technology of critical care and the escalating costs associated with providing that care, have been motivating factors for critical care practitioner to identify and implement &dquo;best&dquo; medical practices. Individual best practices are often determined based on their association with improvements in patient outcomes, increased efficiency and cost-effectiveness of medical care, or both. These practices should ideally be determined based on sound medical evidence obtained from rigorously performed clinical trials, the most rigorous being randomized controlled trials.However, such trials have often not been performed for many aspects of critical care medicine. Outcomes research is an emerging field which attempts, in part, to use variations in medical practices, as well as formal scientific investigations, to identify important associations between specific medical practices and clinical outcomes. This review focuses on two areas of mechanical ventilation, acute respiratory distress syndrome (ARDS) and weaning, to illustrate how outcomes research can be employed to facilitate decision making in the management of patients with respiratory failure.