Early versus late tracheotomy in the ICU
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KeywordsPublic Health Pneumonia Mechanical Ventilation Emergency Medicine Sedation Administration
This study was conducted to compare early versus late tracheotomy in ICU patients.
A total of 103 patients (81 men, 22 women) were included in this study. They were classified into two groups: Group A – early tracheotomy (≤ 7 days) included 36 patients (mean age 55.14 ± 17.698 years), and Group B – late tracheotomy (>7 days) included 67 patients (mean age 56.55 ± 19.078 years). We studied the impact of timing of tracheotomy on the duration of mechanical ventilation, duration of weaning, length of stay in the ICU (LOS), outcome in 28 days, incidence of ventilator-associated pneumonia (VAP), and days of sedation administration. Severity of illness and organ dysfunction were assessed by APACHE II, SAPS and SOFA scores. Statistical analysis was performed using the Pearson ×2, independent t test, Levene significance control, Mann–Whitney U test, and paired t test. The control criterion was P (significance) ≤ a (significance level), a = 5%.
The two groups were comparable in terms of age, APACHE II score and SAPS. There was a statistically significant difference in the admission SOFA score (P <<a), the SOFA score of the tracheotomy day (P = 0.003) and in SOFA max (P <<a), as well as the total days of mechanical ventilation (Group A 18.36 ± 12.059 vs Group B 24.19 ± 14.27, P = 0.05) and the LOS (Group A 16.75 ± 7.038 vs Group B 22.51 ± 10.726, P = 0.007). No difference was observed regarding the days of weaning after tracheotomy (Group A 7.56 ± 6.135 vs Group B 9.19 ± 9.24) and mortality (25% vs 23.9%, respectively). The prevalence of VAP was evaluated in 58 patients. In Group A VAP developed in 23.1%, vs 76.9% of patients in Group B (P = 0.099). There was no difference in the day VAP was diagnosed (P = 0.959). A significant difference in the days of sedative administration before and after tracheotomy was observed in both groups (before: 7.49 ± 5.34 days, after: 4.76 ± 8.05 days, P = 0.005). Days of sedative administration before tracheotomy were significantly different (Group A 4.32 ± 2.083 vs Group B 9 ± 5.690, P = 0.003).
Our results reinforce the findings of previous studies showing that early tracheotomy decreases significantly the duration of mechanical ventilation, ICU LOS and total days of sedative administration, and may provide a benefit in reducing the occurrence of VAP.
This article is published under license to BioMed Central Ltd.