“HYPER-EARLY” Tracheostomy within 48 hours has less Complications and Better Prognosis Compared to Traditional Tracheostomy

Abstract

Introduction Tracheostomies may be performed “early” or “late.” There is no agreement on the best timing for tracheostomy. This study compares tracheostomies and complications when performed within 48 hours with those performed from 48 hours to 21 days. Methods Patients who underwent tracheostomy in the 2017-2018 National Trauma Data Bank (NTDB) were categorized into 2 groups: early tracheostomy (≤48 hours) and late tracheostomy (>48 hours to 21 days). Primary outcome measured was mortality. Chi square models, Mann-Whitney U Test, and multivariate logistics were used for data analysis. Results 843 patients had tracheostomy performed, of which 16% underwent early tracheostomy. Majority were male in both early (84%) and late (74%) tracheostomy groups. Mortality was not statically significant in early (13%) or late (9%) ( P = .151). Total duration of ventilation in early tracheostomy group was less (5 days) compared to late tracheostomy group (16 days, P < .001). Patients with late tracheostomy had almost 18% cases of ventilator-associated pneumonia (VAP) when compared to early tracheostomy patients (7%, P < .001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27 days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20 days) than late tracheostomy patients ( P<.001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27 days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20 days) than late tracheostomy patients ( P < .001). Conclusion Tracheostomy performed as early as 48 hours is beneficial as it demonstrates a decrease time on ventilator, decreased HLOS, as well as lower VAP rates. Our data shows “hyper-early” tracheostomies might be more beneficial that the current national practice.

A retrospective analysis of COVID‐19 tracheostomies: Early versus late tracheostomy

“…A Cochrane review from 2015 by Andriolo et al, did not suggest any mortality benefit or significant difference between ET and LT. 10 Other studies have demonstrated a possible benefit to ET performance in non‐COVID patients. 11 , 12 However, since the COVID‐19 pandemic, there has been much conflicting data within the literature. Ji et al performed the first systematic review on the timing of tracheostomy and clinical outcomes in COVID‐19 patients.…”

Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression

“…When aaplying definitions for early and late tracheostomy timing (14 days or 16.7 days as cut-offs) only 16.7 days cut-off reported differences in mortality being higher in the late group than the early tracheostomy group, not confirming the results of other meta-analyses [12][13][14]25 . An early tracheostomy performance demonstrated possible beneficial effects on outcome in non-COVID-19 patients 29,30 . However, this not really accounts for the real impact in terms of benefits or harm on patients' outcome, because of critically ill patients present a high likelihood of evolving to multiple organ dysfunction that cannot be optimally predicted during the first days of ICU admission 11 .…”