title: Early tracheotomy in elderly patients results in less ventilator-associated pneumonia.
abstract: OBJECTIVE
  To determine if the timing of tracheotomy in elderly patients results in less ventilator associated-pneumonia, mortality, and morbidity.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  This study included 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007. Patient demographics, outcomes, and ventilation data were collected and analyzed.
  
  
  RESULTS
  The early tracheotomy group (continuous intubation time <7 days) included 43 patients, and 115 patients were included in the late group. There were no statistically significant differences in the demographics of the two groups. A statistically significant difference in the rate of ventilator-associated pneumonia was noted in the early versus late tracheotomy group (-0.29% VAP, 95% CI: -0.46, -0.12). There were more intubations per patient noted in the early tracheotomy group versus the late tracheotomy group (0.70 intubations, 95% CI: 0.41, 0.99). The early tracheotomy group has a lower total ICU admission time (-9.5 days, 95% CI: -21.81, -2.25) and total hospital admission time (-10 days, 95% CI: -33.69, -2.249). There was no difference in mortality, although there was a trend of lower mortality in the early tracheotomy group (-11.3% mortality, 95% CI: -0.27, -0.05).
  
  
  CONCLUSIONS
  Early tracheotomy in elderly patients is associated with less ventilator-associated pneumonia, more frequent intubations, less total admission time, and a trend toward lower mortality.
authors.affiliation: Department of Otolaryngology, University of Rochester, Rochester, NY, USA. Glenn_Schneider@urmc.rochester.edu
authors.forename: Glenn Todd
authors.initials: GT
authors.lastname: Schneider
authors.forename: Nathan
authors.initials: N
authors.lastname: Christensen
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Doerr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014140:Tracheotomy