Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients

Bradley D. Freeman, Ingrid B. Borecki, Craig M. Coopersmith, Timothy G. Buchman

Research output: Contribution to journalArticlepeer-review

133 Scopus citations

Abstract

Objective: Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking. We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice. Design: Analysis of Project Impact, a multi-institutional critical care administrative database. Setting: Medical school. Patients: Data from 43,916 patients were reviewed. Interventions: None. Measurements and Main Results: Tracheostomy was performed in 2,473 (5.6%) of 43,916 patients analyzed. Tracheostomy patients had a higher survival rate than nontracheostomy patients (78.1 vs. 71.7%, p < .001) and underwent this procedure following a median (25th-75th percentile) of 9.0 (5.0-14.0) days of ventilatory support. Tracheostomy frequency and timing varied significantly comparing patient, intensive care unit, and hospital characteristics (p < .05 for all). Tracheostomy timing correlated significantly with duration of mechanical ventilation (r = .690), intensive care unit (r = .610), and hospital length of stay (r = .341, p < .001 for all). At most, 22% of patients were supported via tracheostomy at any given time. Although a minority, tracheostomy patients accounted for 26.2%, 21.0%, and 13.5% of all ventilator, intensive care unit, and hospital days, respectively. Conclusions: Although practice varies substantially, tracheostomy timing appears significantly associated with duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay. These findings emphasize the need for an adequately supported multiple-center trial to better define patient selection for tracheostomy and to test the hypothesis that timing of this procedure influences clinically important outcomes.

Original languageEnglish
Pages (from-to)2513-2520
Number of pages8
JournalCritical care medicine
Volume33
Issue number11
DOIs
StatePublished - Nov 2005

Keywords

  • Artificial respiration
  • Health expenditures
  • Outcome assessment
  • Physician's practice patterns
  • Respiratory insufficiency
  • Tracheostomy

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