Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients.
OBJECTIVE
Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking. We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice.


METHODS
Analysis of Project Impact, a multi-institutional critical care administrative database.


METHODS
Medical school.


METHODS
Data from 43,916 patients were reviewed.


METHODS
None.


RESULTS
Tracheostomy was performed in 2,473 (5.6%) of 43,916 patients analyzed. Tracheostomy patients had a higher survival rate than nontracheostomy patients (78.1 vs. 71.7%, p < .001) and underwent this procedure following a median (25th-75th percentile) of 9.0 (5.0-14.0) days of ventilatory support. Tracheostomy frequency and timing varied significantly comparing patient, intensive care unit, and hospital characteristics (p < .05 for all). Tracheostomy timing correlated significantly with duration of mechanical ventilation (r = .690), intensive care unit (r = .610), and hospital length of stay (r = .341, p < .001 for all). At most, 22% of patients were supported via tracheostomy at any given time. Although a minority, tracheostomy patients accounted for 26.2%, 21.0%, and 13.5% of all ventilator, intensive care unit, and hospital days, respectively.


CONCLUSIONS
Although practice varies substantially, tracheostomy timing appears significantly associated with duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay. These findings emphasize the need for an adequately supported multiple-center trial to better define patient selection for tracheostomy and to test the hypothesis that timing of this procedure influences clinically important outcomes.
Freeman
Bradley D
BD
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Borecki
Ingrid B
IB
Coopersmith
Craig M
CM
Buchman
Timothy G
TG
D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D015337:Multicenter Studies as Topic; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy*; D013997:Time Factors; D014139:Tracheostomy; D014481:United States