Early vs Late Tracheotomy for Prevention of Pneumonia in Mechanically Ventilated Adult ICU Patients

Abstract

clinicaltrials.gov Identifier: NCT00262431.

Respiratory Care Year in Review 2013: Airway Management, Noninvasive Monitoring, and Invasive Mechanical Ventilation

“…65 These results were challenged by a multi-center RCT that evaluated early (6 -9 days) versus late (13-15 days) tracheostomy in 419 patients after initiation of mechanical ventilation. 66 There was no difference in the primary end point of VAP, and 39% of patients had an adverse event associated with the placement of the tracheostomy. Importantly, nearly half of the patients randomized to the late group never required a tracheostomy, suggesting that clinicians are poor at determining who needs this procedure.…”

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

“…Despite different inclusion criteria and definitions of ''early'' versus ''late'' tracheostomy, recently published randomized clinical trials [21][22][23][24] indicate that early tracheostomy is not associated with reduced mortality or ICU-acquired infections. Studies in selected patient populations are warranted.…”

What’s new with tracheostomy?

“…Recent large randomized controlled trials (RCTs) of tracheostomy timing have shifted the pendulum towards delaying tracheostomy decisions, at least among general medical-surgical and cardiac surgery patients [10][11][12][13]. Despite differing inclusion criteria and definitions of ''early'' versus ''late'' tracheostomy, these trials indicate that the routine performance of earlier tracheostomies is unlikely to reduce mortality or prevent nosocomial infections.…”

“…Despite differing inclusion criteria and definitions of ''early'' versus ''late'' tracheostomy, these trials indicate that the routine performance of earlier tracheostomies is unlikely to reduce mortality or prevent nosocomial infections. The Early versus Late Tracheotomy Study (ELTS) showed that earlier tracheostomies can decrease mechanical ventilation duration and length of stay in the ICU, but that this did not translate into shorter hospitalizations [12]. Most importantly, in two of these RCTs (ELTS and the ''TracMan'' trial) a surprisingly large proportion of patients assigned to receive delayed tracheostomies were successfully extubated without ever having received the procedure (43 and 54 %, respectively) [12,13].…”

“…The Early versus Late Tracheotomy Study (ELTS) showed that earlier tracheostomies can decrease mechanical ventilation duration and length of stay in the ICU, but that this did not translate into shorter hospitalizations [12]. Most importantly, in two of these RCTs (ELTS and the ''TracMan'' trial) a surprisingly large proportion of patients assigned to receive delayed tracheostomies were successfully extubated without ever having received the procedure (43 and 54 %, respectively) [12,13]. Therefore, routinely performing tracheostomies earlier than 4 (TracMan) to 8 days (ELTS) may subject many patients to unnecessary procedures, suggesting that tracheostomies should probably be postponed until after 10 (TracMan) to 15 days (ELTS).…”