Timing and Outcome of Tracheostomy in Critical Care Patients

Hypothesis: There is considerable controverse about appropriate timing of tracheostomy in intensive care units patients. Tracheostomy has advantages over long term intubation including better patient comfort, facilitation of nursing care, early oral feeding and less laryngeal damage. Besides, patients receiving early tracheostomy are reported to have shorter duration of mechanical ventilation and less incidence of ventilation associated pneumonia. Others did not find benefit to early tracheostomy. Material and Methods: Forty six patients were included in this study. All the patients were on mechanical ventilation in ICU in DSFH, Jeddah, K.S.A. and had tracheostomy done from January 2002 to January 2005. The patients were divided into 2 groups according to the timing of tracheostomy. The 2 groups were compared regarding duration of mechanical ventilation (MV), ventilation associated pneumonia (VAP), ICU Length of stay (ICU LOS), hospital length of stay (Hospital LOS) and hospital mortality. Results: Duration of MV, ICU LOS, and Hospital LOS were significantly less in early tracheostomy group. The incidence of VAP was significantly less in early tracheostomy group. There was no significant difference between the 2 groups in incidence of hospital mortality. Conclusion: Early tracheostomy should be considered in patients on MV as it has advantages over long term intubation.