title: Early versus late tracheostomy in cardiovascular intensive care patients.
abstract: BACKGROUND
  Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population.
  
  
  METHODS
  After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as "early" if < 7 days or "late" if ≥ 7 days post-cardiac surgery).
  
  
  RESULTS
  14,101 patients underwent cardiac surgery over the 7-year study period; from those, 147 (1.36%) received tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P=0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups.
  
  
  CONCLUSIONS
  There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.
authors.forename: Wilfredo
authors.initials: W
authors.lastname: Puentes
authors.forename: Angela
authors.initials: A
authors.lastname: Jerath
authors.forename: George
authors.initials: G
authors.lastname: Djaiani
authors.forename: Rosa
authors.initials: R
authors.lastname: Cabrerizo Sanchez
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network; Department of Anesthesia, Faculty of Medicine, University of Toronto, Canada. marcin.wasowicz@uhn.ca.
authors.forename: Marcin
authors.initials: M
authors.lastname: Wąsowicz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000379:methods; D002318:Cardiovascular Diseases / Q000628:therapy*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D014139:Tracheostomy / Q000379:methods*
keywords: cardiac surgery; intensive care; prolonged mechanical ventilation; tracheostomy