Early versus Late Tracheostomy in Critically Ill Patients Requiring Prolonged Mechanical Ventilation: A Single-Center Retrospective Cohort Study
DOI:
https://doi.org/10.51168/4vct9m95Keywords:
tracheostomy, mechanical ventilation, intensive care unit, sedation, ventilator-associated pneumonia, mortalityAbstract
Background:
The optimal timing of tracheostomy in critically ill patients requiring prolonged invasive mechanical ventilation remains uncertain. Early tracheostomy may facilitate ventilator weaning, reduce sedation exposure, and shorten intensive care unit (ICU) stay.
Objective:
To compare clinical outcomes between early and late tracheostomy in critically ill adults requiring prolonged invasive mechanical ventilation.
Methods:
This single-center retrospective cohort study included 140 adult ICU patients who underwent tracheostomy between April 1, 2024, and April 1, 2025. Patients were categorized as early tracheostomy (≤7 days; n=70) or late tracheostomy (>7 days; n=70). The primary outcome was duration of mechanical ventilation. Secondary outcomes included sedation duration, ICU and hospital length of stay, ventilator-associated pneumonia (VAP), and mortality.
Results:
Baseline characteristics and illness severity were comparable between groups, including APACHE II scores (18.6 ± 5.2 vs 19.1 ± 5.5; p=0.56) and SOFA scores (7.8 ± 2.3 vs 8.1 ± 2.5; p=0.44). Early tracheostomy was associated with shorter mechanical ventilation (10.8 ± 4.2 vs 15.6 ± 5.1 days; p<0.001), sedation duration (7.2 ± 3.1 vs 11.4 ± 4.3 days; p<0.001), and ICU stay (12.6 ± 5.3 vs 18.1 ± 6.2 days; p<0.001). VAP occurred less frequently (17.1% vs 34.3%; p=0.02), while mortality did not differ significantly.
Conclusion:
Early tracheostomy was associated with shorter ventilation and ICU stay and lower VAP incidence, without a significant mortality difference.
Recommendation:
Tracheostomy timing should be individualized based on clinical condition and anticipated duration of ventilatory support, and prospective multicenter studies are recommended to further evaluate optimal timing and long-term outcomes.
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