Association of early versus late tracheostomy with prognosis in hypoxic-ischaemic encephalopathy patients: A propensity-matched cohort study.

Abstract

Background: The optimal timing for exchanging an endotracheal tube for a tracheostomy cannula in patients with hypoxic-ischaemic encephalopathy is controversial.

Aim: This study aimed to evaluate the effects of early versus late tracheostomy on the prognosis of patients with hypoxic-ischaemic encephalopathy.

Study design: The study was an observational retrospective study that followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. We included adults with hypoxic-ischaemic encephalopathy who underwent tracheostomy between January 2012 and September 2020. The patients were classified into early or late tracheostomy groups. To eliminate differences in baseline characteristics, propensity score matching was conducted, and the outcomes between the two groups were compared.

Results: A total of 132 patients were included, and through propensity score matching, 54 pairs of patients were matched. The early tracheostomy group showed a significant reduction in the duration of mechanical ventilation (median, 12 days; interquartile range 7-20 vs. median, 28 days; interquartile range, 15.75-58.25, p < .001), intensive care unit length of stay (median, 14.5 days; interquartile range, 6.75-26 vs. median, 35 days; interquartile range, 20-59, p < .001) and hospital length of stay (median, 19.5 days; interquartile range, 10.87-36.5 vs. median, 39.5 days; interquartile range, 22-66, p < .001). Over a 1-year follow-up period, there were no significant differences between the two groups regarding inhospital mortality (57.4% vs. 46.3%, p = .248), 30-day mortality (59.3% vs. 46.3%, p = .177) and 1-year mortality (61.1% vs. 48.1%, p = .176).

Conclusions: In patients with hypoxic-ischaemic encephalopathy undergoing mechanical ventilation, early tracheostomy is associated with a reduction in the duration of mechanical ventilation and decreased intensive care unit and hospital length of stay.

Relevance to clinical practice: For patients with hypoxic-ischaemic encephalopathy who are at a high risk of requiring prolonged mechanical ventilation, the benefits of early tracheostomy suggest considering it a viable treatment option.