title: Impact of early vs. late tracheostomy on weaning: a retrospective analysis.
abstract: BACKGROUND
  Early tracheostomy has been advocated for a number of reasons. Especially in association with weaning from mechanical ventilation, it is known that an early timepoint can help patients being weaned more rapidly from the ventilator. However, timing of tracheostomy is still unknown and evidence is lacking. The effects of early tracheostomy compared with intermediate and late tracheostomy were assessed in critically ill patients.
  
  
  METHODS
  Data collected from January 2005 to December 2007 were conducted for retrospective analysis. All patients needing tracheostomy due to extubation failure and/or weaning failure were included (N.=296). Early tracheostomy (ET) was defined as ≤4 days, intermediate tracheostomy (IT) as tracheostomy within 5-9 days, and late tracheostomy (LT) was defined as ≥10 days after endotracheal intubation. After proving normal distribution, significant changes between the three groups were tested by ANOVA followed by post hoc tests for multiple comparisons (Bonferroni's test).
  
  
  RESULTS
  Intensive care unit (ICU) mortality was significantly higher in the LT group when being compared with the ET but not when being compared with the IT group (40.7% vs. 24.8% vs. 17.1%). Further, a significantly reduced incidence of VAP and sepsis, a smaller amount of ventilator days and a shorter ICU length of stay could be observed for the ET group. Length of weaning was not significantly different between the groups.
  
  
  CONCLUSIONS
  The length of weaning after tracheostomy is not affected by the timing. It seems beneficial to favour early tracheostomy in order to reduce the time of mechanical ventilation and its associated risks.
authors: Department of Intensive Care, University Hospital Aachen, RWTH Aachen University, Aachen, Germany. jbickenbach@ukaachen.de
authors: J
authors: J
authors: Bickenbach
authors: M
authors: M
authors: Fries
authors: V
authors: V
authors: Offermanns
authors: R
authors: R
authors: Von Stillfried
authors: R
authors: R
authors: Rossaint
authors: G
authors: G
authors: Marx
authors: R
authors: R
authors: Dembinski