Volume 147, Issue 1 p. 44-51
General Otolaryngology

Tracheotomy Timing and Outcomes in the Critically Ill

Charles C. L. Tong MS

Charles C. L. Tong MS

Department of Otolaryngology–Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA

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Andrew J. Kleinberger MD

Andrew J. Kleinberger MD

Department of Otolaryngology–Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA

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Jacqueline Paolino

Jacqueline Paolino

Department of Otolaryngology–Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA

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Kenneth W. Altman MD, PhD

Corresponding Author

Kenneth W. Altman MD, PhD

Department of Otolaryngology–Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA

Kenneth W. Altman, MD, PhD, Director, Eugen Grabscheid, M.D. Voice Center, Associate Professor of Otolaryngology, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA Email: [email protected]Search for more papers by this author
First published: 12 March 2012
Citations: 5

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

This article was presented at the 2011 AAO-HNSF Annual Meeting & OTO EXPO; September 11-14, 2011; San Francisco, California.

Abstract

Objective

To examine the impact of early tracheotomy in nontrauma patients on duration of mechanical ventilation (MV), intensive care unit (ICU) stay, and overall hospital stay.

Design

Case series with chart review.

Setting

Tertiary care medical center.

Methods

A retrospective study was performed for patients undergoing tracheotomy from 2005 to 2010. Demographics; survival; duration of endotracheal intubation, MV, ICU, and overall hospital stay; and incidence of ventilator-associated pneumonia (VAP) were assessed. Tracheotomy was considered early if it was performed by day 7 of MV and late thereafter. Nonparametric statistics were used to compare results from each group.

Results

Of the 592 patients included in the analysis, 128 received tracheotomy early and 464 late. Differences between age, sex, and overall survival were not statistically significant. Duration of MV was 45% less (mean ± standard error: 21.47 ± 1.86 days vs 39.33 ± 1.33 days; P <. 001), total ICU stay was shortened by 33% (17.52 ± 1.38 days vs 26.27 ± 0.73 days; P <. 001), and length of overall hospital course was reduced by 34% (35.85 ± 2.57 days vs 54.28 ± 1.60 days; P <. 001) in the early tracheotomy group. Three patients (2.3%) from the early tracheotomy group developed VAP as compared with 15 (3.2%) from the late group. Duration from tracheotomy to ICU transfer and 30% overall mortality did not differ significantly between groups.

Conclusion

Early tracheotomy in ICU patients is associated with earlier ICU discharge, shorter duration of mechanical ventilation, and decreased length of overall hospital stay without affecting mortality.