The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital

Abstract

Objectives The timing of tracheostomy for critically ill patients on mechanical ventilation (MV) is a topic of controversy. Our objective was to determine the most suitable timing for tracheostomy in patients undergoing MV. Design Retrospective cohort study. Setting and participants One thousand eight hundred eighty-four hospitalisations received tracheostomy from January 2011 to December 2020 in a Chinese tertiary hospital. Methods Tracheostomy timing was divided into three groups: early tracheostomy (ET), intermediate tracheostomy (IMT), and late tracheostomy (LT), based on the duration from tracheal intubation to tracheostomy. We established two criteria to classify the timing of tracheostomy for data analysis: Criteria I (ET ≤ 5 days, 5 days < IMT ≤ 10 days, LT > 10 days) and Criteria II (ET ≤ 7 days, 7 days < IMT ≤ 14 days, LT > 14 days). Parameters such as length of ICU stay, length of hospital stay, and duration of MV were used to evaluate outcomes. Additionally, the outcomes were categorized as good prognosis, poor prognosis, and death based on the manner of hospital discharge. Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, Chi-square test, and Fisher’s exact test were employed as appropriate to assess differences in demographic data and individual characteristics among the ET, IMT, and LT groups. Univariate Cox regression model and multivariable Cox proportional hazards regression model were utilized to determine whether delaying tracheostomy would increase the risk of death. Results In both of two criterion, patients with delayed tracheostomies had longer hospital stays (p < 0.001), ICU stays (p < 0.001), total time receiving MV (p < 0.001), time receiving MV before tracheostomy (p < 0.001), time receiving MV after tracheostomy (p < 0.001), and sedation durations. Similar results were also found in sub-population diagnosed as trauma, neurogenic or digestive disorders. Multinomial Logistic regression identified LT was independently associated with poor prognosis, whereas ET conferred no clinical benefits compared with IMT. Conclusions In a mixed ICU population, delayed tracheostomy prolonged ICU and hospital stays, sedation durations, and time receiving MV. Multinomial logistic regression analysis identified delayed tracheostomies as independently correlated with worse outcomes. Trial registration ChiCTR2100043905. Registered 05 March 2021.http://www.chictr.org.cn/listbycreater.aspx

Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study

“…In a retrospective cohort study involving 1884 general intensive care unit patients, the patients were divided into subgroups based on their admission diagnoses, and tracheostomies performed within 7 days, between 7 and 14 days, and after 14 days were examined. That study found that delayed tracheostomy was associated with prolonged ICU stay, increased sedation requirements, and prolonged mechanical ventilation duration [21].…”

Early Versus Late Tracheotomy in the Intensive Care Unit

“…These findings coincided with data from a retrospective study by Zhao J et Al. [5], in which patients with late tracheotomy had a longer hospital stay of 39 days on average, p < 0.001 and in the cohort study of Fernanda Kazmierski Morakami et al [6] where patients with early vs. late tracheotomy had a shorter hospital stay (42 ± 32 vs. 52 ± 50 days, p < 0.001).…”