Early tracheostomy versus late tracheostomy in the surgical intensive care unit.
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.
Möller
Mecker G
MG
Grand Rapids/Michigan State University General Surgery Residency, Grand Rapids Medical Education and Research Center for the Health Professions, 221 Michigan St. N.E., Ste. 200-A, Grand Rapids, MI 49503, USA.
Slaikeu
Jason D
JD
Bonelli
Pablo
P
Davis
Alan T
AT
Hoogeboom
James E
JE
Bonnell
Bruce W
BW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy; D012122:Ventilators, Mechanical / Q000009:adverse effects