Early tracheostomy for primary airway management in the surgical critical care setting

TLDR

The study prospectively analyzed admission, operative, ventilatory, and outcome variables to assess the impact of early tracheostomy on duration of mechanical ventilation, ICU stay, and hospital stay. In a 12‑month prospective cohort of 264 mechanically ventilated trauma patients, 106 underwent tracheostomy, with 51 receiving it early (1–7 days) and 55 late (≥8 days), and morbidity and mortality were evaluated. Early tracheostomy significantly reduced ventilator days, ICU length of stay, and hospital stay compared with prolonged endotracheal intubation, with no procedure‑related deaths and a 4% morbidity rate, indicating a risk equivalent to intubation and supporting its use when intubation is expected to exceed seven days. Published in Surgery 1990;108:655–9.

Abstract

Abstract During a 12-month period, 264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit. One hundred twenty patients (46%) were disengaged from the ventilator, and 38 patients (14%) died. Of the remaining 106 patients (40%) 51 patients (group I) were to receive tracheostomy within 1 to 7 days, and 55 patients (group II) underwent late (8 or more days after admission) tracheostomy. Multiple variables in four categories (admission, operative, ventilatory, and outcome) were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were assessed. Early tracheostomy, in a homogeneous group of critically ill patients, is associated with a significant decrease in duration of mechanical ventilation, as well as shorter intensive care unit and hospital stays, compared with translaryngeal endotracheal intubation. There were no deaths attributable to tracheostomy, and overall morbidity of the procedures was 4%. We conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation. Furthermore, early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation. (Surgery 1990;108:655–9.)