Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study.
BACKGROUND
Long-term ventilation in intensive care units (ICUs) is associated with several problems such as increased mortality, increased rates of ventilator-associated pneumonia (VAP), and prolonged time of hospitalization, and thus leads to enormous healthcare expenditure. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient's mortality is still controversial. The aim of our study was to investigate whether early tracheostomy improved outcome in critically ill patients.


METHODS
Within 2 years, 100 critically ill, predominantly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy was performed either early (≤4 days, 2.8 days median) or late (≥6 days, 8.1 days median) after intubation.


RESULTS
We could demonstrate that mortality was not significantly reduced in the early tracheostomy (ET) group in contrast to the late tracheostomy (LT) group. ET was associated with decreased VAP incidence (ET 38% vs. LT 64%), decreased duration of ventilation (ET 367.5 h vs LT 507.5 h), and shorter time of hospitalization both in hospital (ET 31.5 days vs LT 68 days) and in ICU (ET 21.5 days vs LT 27 days).


CONCLUSIONS
Despite many advantages like reduced time of ventilation and hospitalization, early tracheostomy is not associated with decreased mortality in critically ill patients.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Gießen, Rudolf-Buchheim-Straße 7, Gießen, Germany.
Tillo
T
Koch
Birgit
B
Hecker
Andreas
A
Hecker
Florian
F
Brenck
Matthias
M
Preuß
Thorsten
T
Schmelzer
Winfried
W
Padberg
Markus A
MA
Weigand
Joachim
J
Klasen
D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012121:Respiration, Artificial / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014139:Tracheostomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D015300:Ventilator Weaning