Scientific papers
Early tracheostomy versus late tracheostomy in the surgical intensive care unit

Presented at the 47th Annual Meeting of the Midwest Surgical Association, Mackinac Island, Michigan, August 15–18, 2004
https://doi.org/10.1016/j.amjsurg.2005.01.002Get rights and content

Abstract

Background

This study’s purpose was to determine if early tracheostomy (ET) of severely injured patients reduces days of ventilatory support, the frequency of ventilator-associated pneumonia (VAP), and surgical intensive care unit (SICU) length of stay (LOS).

Methods

This 2-year retrospective review included 185 SICU patients with acute injuries requiring mechanical ventilation and tracheostomy. ET was defined as 7 days or less, and late tracheostomy (LT) as more than 7 days.

Results

The incidence of VAP was significantly higher in the LT group, relative to the ET group (42.3% vs. 27.2%, respectively; P <.05). Acute Physiology and Chronic Health Evaluation II scores, hospital and SICU LOS, and the number of ventilator days were significantly higher in the LT group.

Conclusions

In patients who required prolonged mechanical ventilation, there was significant decreased incidence of VAP, less ventilator time, and lower ICU LOS when tracheostomy was performed within 7 days after admission to the SICU.

Section snippets

Methods

This project was designed as a retrospective study from 2000 through 2002 of SICU patients from a tertiary referral hospital, which included a level I trauma center. The study group included 185 patients, ages 16 to 80 years, who were admitted to the SICU by the trauma, general surgery, cardiothoracic, neurology, and neurosurgery services. All of the patients had acute injuries requiring mechanical ventilation and tracheostomy. A percutaneous or open tracheostomy procedure was performed, based

Results

The demographic data for the patients in the 2 groups are shown in Table 1. For the entire data set of 185 patients, the age was 52.2 ± 1.5 years, and 62% of the subjects were males. More than 50% of the admissions were from the trauma service, and 16% of the subjects had at least 1 of the following morbidities: COPD, diabetes, CHF, or CRF. The mean APACHE II score was 22.9 ± 0.6. The APACHE II score was significantly higher in the LT group, relative to patients in the ET group. A significantly

Comments

Tracheostomy has an important role in the airway management of ICU patients [8]. Several studies [1], [9], [10], [11], [12] have identified the benefits of tracheostomy over endotracheal intubation, such as sparing further injury from translaryngeal intubation, providing a stable airway, facilitating pulmonary toilet, increasing patient comfort and mobility, permitting speech and feedings, and facilitating weaning from the ventilator [5]. Despite several studies [3], [4], [5], [6], [7], [13],

Conclusions

Our results reinforce the findings of previous studies showing that ET decreases the incidence of VAP, ventilator time, ICU LOS, and hospital LOS. In addition, our study adds new evidence that earlier tracheostomy may result in greater reduction of VAP when prolonged mechanical ventilation is expected. In those patients who will require mechanical ventilation for more than 1 week, we recommend that tracheostomy be performed between day 3 and 7, in order to obtain greater benefit. More

Acknowledgments

The authors wish to express their gratitude for the assistance of Colleen Clonan, R.N. (Database Coordinator, Quality Department, Spectrum Health, Grand Rapids, MI 49503, USA) in the acquisition of the data for the manuscript.

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