A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.
OBJECTIVE
The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed.


METHODS
Prospective, randomized study.


METHODS
Medical intensive care units.


METHODS
One hundred and twenty patients projected to need ventilation >14 days.


METHODS
None.


RESULTS
Patients were prospectively randomized to either early percutaneous tracheotomy within 48 hrs or delayed tracheotomy at days 14-16. Time in the intensive care unit and on mechanical ventilation and the cumulative frequency of pneumonia, mortality, and accidental extubation were documented. The airway was assessed for oral, labial, laryngeal, and tracheal damage. Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group.


CONCLUSIONS
This study demonstrates that the benefits of early tracheotomy outweigh the risks of prolonged translaryngeal intubation. It gives credence to the practice of subjecting this group of critically ill medical patients to early tracheotomy rather than delayed tracheotomy.
Department of Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, Tampa General Hospital University of South Florida Health Science Center, Tampa, FL 33612, USA. dmrumcake@AOL.com
Mark J
MJ
Rumbak
Michael
M
Newton
Thomas
T
Truncale
Skai W
SW
Schwartz
James W
JW
Adams
Patrick B
PB
Hazard
D016292:Procedural Sedation / Q000706:statistics & numerical data; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005431:Florida; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007830:Larynx / Q000293:injuries; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000293:injuries; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013714:Tennessee; D013997:Time Factors; D014132:Trachea / Q000293:injuries; D014140:Tracheotomy / Q000009:adverse effects / Q000379:methods*