Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study

Abstract

IntroductionTracheostomy is frequently performed in critically ill patients for prolonged intubation. However, the optimal timing of tracheostomy, and its impact on weaning from mechanical ventilation and outcomes in critically ill patients who require mechanical ventilation remain controversial.MethodsThe medical records of patients who underwent tracheostomy in the medical intensive care unit (ICU) of a tertiary medical centre from July 1998 to June 2001 were reviewed. Clinical characteristics, length of stay in the ICU, rates of post-tracheostomy pneumonia, weaning from mechanical ventilation and mortality rates were analyzed.ResultsA total of 163 patients (93 men and 70 women) were included; their mean age was 70 years. Patients were classified into two groups: successful weaning (n = 78) and failure to wean (n = 85). Shorter intubation periods (P = 0.02), length of ICU stay (P = 0.001) and post-tracheostomy ICU stay (P = 0.005) were noted in patients in the successful weaning group. Patients who underwent tracheostomy more than 3 weeks after intubation had higher ICU mortality rates and rates of weaning failure. The length of intubation correlated with the length of ICU stay in the successful weaning group (r = 0.70; P < 0.001). Multivariate analysis revealed that tracheostomy after 3 weeks of intubation, poor oxygenation before tracheostomy (arterial oxygen tension/fractional inspired oxygen ratio <250) and occurrence of nosocomial pneumonia after tracheostomy were independent predictors of weaning failure.ConclusionThe study suggests that tracheostomy after 21 days of intubation is associated with a higher rate of failure to wean from mechanical ventilation, longer ICU stay and higher ICU mortality.

Predictors of Successful Decannulation Using a Tracheostomy Retainer in Patients with Prolonged Weaning and Persisting Respiratory Failure

“…Moreover, the duration of the preceding intubation and tracheostomy were associated with decannulation success. In line with this, Hsu et al [23] recorded shorter intubation periods, length of ICU stay and posttracheostomy ICU stay in patients with successful weaning. An important finding was that recannulation delayed the discharge from the weaning center by as much as 14 days.…”

Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

“…They also showed that the duration of intubation before tracheostomy was correlated with the length of ICU stay in patients who weaned successfully. [5]…”

“…The timing of tracheostomy depends on different factors, such as patients’ clinical conditions, physician judgment, and communication with patients’ families. [5] In the recent American College of Chest Physicians (ACCP) guidelines,[6] some physicians suggest that tracheostomy should be considered after an initial period of stabilization on the ventilator, when it becomes apparent that the patient will require prolonged ventilator assistance.…”

“…[7] There are different results about the relationship between timing of tracheostomy and duration of mechanical ventilation. [3–57–10] Also there has been little evidence in this relationship among patients with potentially normal lungs. Therefore, we tried to show how the timing of tracheostomy and duration of intubation and mechanical ventilation based on gender could influence the duration of mechanical ventilation.…”

Untitled

“…The lack of a significant effect in the trauma population does not exclude such an effect in other patients' populations. A recent retrospective cohort study on medical ICU patients showed that tracheostomy performed after 21 days of intubation was associated with a higher rate of failure to wean from mechanical ventilation, longer ICU stay and higher ICU mortality [8]. …”