title: Effect of tracheostomy timing on clinical outcome in neurosurgical patients: early versus late tracheostomy.
abstract: BACKGROUND
  The optimal timing of tracheostomy in neurosurgical patients is not well established. This retrospective study was conducted to determine the effect of the timing of tracheostomy on clinical outcome in mechanically ventilated neurosurgical patients admitted to the surgical intensive care unit (ICU).
  
  
  METHODS
  A total of 125 neurosurgical patients, who underwent tracheostomy and had total mechanical ventilation (MV) duration of ≥7 days from October 2007 to December 2011, were enrolled. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 10 days of MV in the early group (group E, n=39), whereas in the late group, it was performed after 10 days of MV (group L, n=86). The ICU and in-hospital mortality rates, total duration of MV, length of stay (LOS) in the ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between both the groups.
  
  
  RESULTS
  The total MV duration and ICU LOS were significantly longer in group L than E (21.5±15.5 vs. 11.4±5.6 d, P<0.001; 31.1±18.2 vs. 19.9±10.6 d, P<0.001). The incidence of VAP before tracheostomy was higher in group L than group E (44 vs. 23%, P<0.05). No significant difference was found in the ICU and in-hospital mortality rates and hospital LOS between the groups.
  
  
  CONCLUSIONS
  Early tracheostomy reduced the MV duration, ICU LOS, and incidence of VAP in critically ill neurosurgical patients. However, early tracheostomy did not reduce either the ICU or hospital mortality.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea.
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Lim
authors.forename: Sue-Young
authors.initials: SY
authors.lastname: Lee
authors.forename: Koung-In
authors.initials: KI
authors.lastname: Woo
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D060666:Airway Extubation; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D010100:Oxygen / Q000097:blood; D053717:Pneumonia, Ventilator-Associated / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D010100:Oxygen