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Abstract

IntroductionDespite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients.MethodsThe following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay.ResultsOf 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P < 0.0001). Similarly, ICU LOS was significantly shorter (10.9 ± 1.2 days versus 21.0 ± 1.3 days; P < 0.0001). Following tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of prolonged ICU stay (>14 days).ConclusionEarly tracheostomy in trauma ICU patients is associated with shorter duration of mechanical ventilation and ICU LOS, without affecting ICU or hospital outcome. Adopting a standardized strategy of early tracheostomy in appropriately selected patients may help in reducing unnecessary resource utilization.

Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact

“…[9102028] In our study, patients who didn’t develop ventilator associated pneumonia were weaned faster than those who developed nosocomial pneumonia (5.9 ± 6.9 days Vs 10.8 ± 12.5 days; P = 0.037). This is not surprising as similar conclusions were found in trauma patients who were ventilated with endotracheal intubation.…”

Demographics and outcomes of critically ill patients transferred from other hospitals to a tertiary care academic referral center in Saudi Arabia

“…This finding reflects the large number of transferred trauma patients who often require this procedure [19-21]. This also reflects the fact that patients often are transferred after they pass the acute phase of critical illness and are in a stage when tracheostomy is indicated.…”

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“…This was not the case because the main finding in our study was a significant reduction in ICU LOS (10.9 ± 1.2 days for the early tracheotomy group versus 21.0 ± 1.3 days for late tracheotomy patients; P < 0.0001). Because our patients were discharged at comparable periods after tracheotomy, as shown in Table 2 of our report [1], the difference in ICU LOS could only be explained by the reduction in pre-tracheotomy duration (i.e. the timing of tracheotomy, or days from ICU admission to tracheotomy: 4.6 ± 0.5 days versus 14.1 ± 0.5 days; P < 0.0001)".…”

“…In our article [1] we addressed the issue of differences in baseline characteristics, namely whether maxillofacial injuries or spinal cord injuries were present. Using multivariate analysis, we found late tracheostomy (odds ratio 6.9, 95% confidence interval 2.6–18.1; P < 0.001) and, to a much lesser extent, spinal cord injury (odds ratio 4.7, 95% confidence interval 0.99–22.6; P = 0.052) to be independent predictors of prolonged ICU stay.…”

“…Regarding the interesting article on early tracheostomy by Arabi and coworkers [1] recently published in Critical Care , we should like to offer the following comments.…”