Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients.
OBJECTIVE
Although several advantages are attributed to tracheotomy in ICU patients requiring mechanical ventilation (MV), true benefits and the optimal timing of tracheotomy remain controversial. In this study, we compared early tracheotomy (ET) with prolonged intubation (PI) in severely ill patients requiring prolonged MV.


METHODS
Prospective, randomized study.


METHODS
Twenty-five medical and surgical ICUs in France.


METHODS
Patients expected to require MV > 7 days.


RESULTS
Patients were randomised to either (open or percutaneous) ET within 4 days or PI. The primary end-point was 28-day mortality. Secondary end-points were: the incidence of ICU-acquired pneumonia, number of d1-d28 ventilator-free days, time spent in the ICU, 60-day mortality, number of septic episodes, amount of sedation, comfort and laryngeal and tracheal complications. A sample size of 470 patients was considered necessary to obtain a reduction from 45 to 32% in 28-day mortality. After 30 months, 123 patients had been included (ET = 61, PI = 62) in 25 centres and the study was prematurely closed. All group characteristics were similar upon admission to ICU. No difference was found between the two groups for any of the primary or secondary end-points. Greater comfort was the sole benefit afforded by tracheotomy after subjective self-assessment by patients.


CONCLUSIONS
The trial did not demonstrate any major benefit of tracheotomy in a general population of ICU patients, as suggested in a previous meta-analysis, but was underpowered to draw any firm conclusions. The potential advantage of ET may be restricted to selected groups of patients.
Blot
François
F
Intensive Care Unit, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France. blot@igr.fr
Similowski
Thomas
T
Trouillet
Jean-Louis
JL
Chardon
Patrick
P
Korach
Jean-Michel
JM
Costa
Marie-Alyette
MA
Journois
Didier
D
Thiéry
Guillaume
G
Fartoukh
Muriel
M
Pipien
Isabelle
I
Bruder
Nicolas
N
Orlikowski
David
D
Tankere
Frédéric
F
Durand-Zaleski
Isabelle
I
Auboyer
Christian
C
Nitenberg
Gérard
G
Holzapfel
Laurent
L
Tenaillon
Alain
A
Chastre
Jean
J
Laplanche
Agnès
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D016019:Survival Analysis; D014139:Tracheostomy / Q000009:adverse effects*; D015300:Ventilator Weaning; D055815:Young Adult