Effect of tracheostomy timing on clinical outcome in neurosurgical patients: early versus late tracheostomy.

BACKGROUND: The optimal timing of tracheostomy in neurosurgical patients is not well established. This retrospective study was conducted to determine the effect of the timing of tracheostomy on clinical outcome in mechanically ventilated neurosurgical patients admitted to the surgical intensive care unit (ICU).

METHODS: A total of 125 neurosurgical patients, who underwent tracheostomy and had total mechanical ventilation (MV) duration of ≥7 days from October 2007 to December 2011, were enrolled. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 10 days of MV in the early group (group E, n=39), whereas in the late group, it was performed after 10 days of MV (group L, n=86). The ICU and in-hospital mortality rates, total duration of MV, length of stay (LOS) in the ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between both the groups.

RESULTS: The total MV duration and ICU LOS were significantly longer in group L than E (21.5±15.5 vs. 11.4±5.6 d, P<0.001; 31.1±18.2 vs. 19.9±10.6 d, P<0.001). The incidence of VAP before tracheostomy was higher in group L than group E (44 vs. 23%, P<0.05). No significant difference was found in the ICU and in-hospital mortality rates and hospital LOS between the groups.

CONCLUSIONS: Early tracheostomy reduced the MV duration, ICU LOS, and incidence of VAP in critically ill neurosurgical patients. However, early tracheostomy did not reduce either the ICU or hospital mortality.