Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study

  • Kang, Yewon (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine) ;
  • Yoo, Wanho (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine) ;
  • Kim, Youngwoong (Department of Trauma Surgery, Pusan National University School of Medicine) ;
  • Ahn, Hyo Yeong (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine) ;
  • Lee, Sang Hee (Department of Internal Medicine, Wonkwang University Sanbon Hospital) ;
  • Lee, Kwangha (Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine)
  • Received : 2019.11.20
  • Accepted : 2020.03.02
  • Published : 2020.04.30
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Abstract

Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

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References

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