Characteristics and outcome of critical care patients undergoing tracheostomy in a medical intensive care setting: A retrospective single center analysis of 1570 procedures in 12 years

Abstract

Tracheostomy is often indicated for patients requiring prolonged ventilation, as it can facilitate weaning from the ventilator, reduce work of breathing and allow cessation of sedation. Optimal timing and mode of tracheostomy is still under debate.

Objective

To evaluate the technique, timing, and clinical outcomes of tracheostomy in a large single-center cohort of medical intensive care unit (ICU) patients.

Methods

A retrospective cohort analysis was conducted on consecutive patients undergoing tracheostomy between 2006 and 2018 in a medical ICU. Patients received either a percutaneous dilatational tracheostomy or surgical tracheostomy. Data collected included patient demographics, APACHE-II scores, ICU mortality, duration of mechanical ventilation, length of ICU stays, tracheostomy technique, and timing of tracheostomy relative to intubation and initiation of mechanical ventilation.

Results

A total of 1570 tracheostomies were analyzed, comprising 1323 (84.2 %) dilatational tracheostomies and 247 (15.8 %) surgical tracheostomies. The type of tracheostomy did not significantly affect length of stays or length of mechanical ventilation. Subgroup analysis based on tracheostomy timing revealed that early tracheostomy (<7 days post-intubation) was associated with shorter length of mechanical ventilation (p < 0.001), reduced length of stays (p < 0.001), and lower mortality (p = 0.01). Multivariate regression analysis identified early tracheostomy as an independent predictor of reduced mortality, while tracheostomy type had no significant effect on mortality outcomes.

Conclusion

Early tracheostomy, within seven days of intubation, was associated with improved survival, shorter length of mechanical ventilation, and reduced ICU stays, independent of the tracheostomy technique in our retrospective cohort in medical ICU patients.