Patients breathing with the aid of mechanical ventilation were no better off if they received a tracheostomy within 4 days of critical care admission than if the procedure was performed later in their hospital stay, according to research in the May 22/29 issue of JAMA. There was not an improvement in 30-day mortality or other important secondary outcomes associated with an early tracheostomy.
“Not only were there no statistically significant difference in mortality between the 2 groups but, through waiting, an invasive procedure was avoided in a third of patients,” the authors wrote. “Early tracheostomy should therefore be avoided unless tools to accurately predict the duration of mechanical ventilation on individual patients can be developed and validated.”
Investigators note the procedure was associated with a 6.3% acute complication rate in the study (and 38%-39% overall complication rates in the other recent multicenter studies), and that it did not appear to be associated with any significant increase in health care resource use, as measured by critical care unit or hospital stay.
“It would appear that delaying a tracheostomy until at least day 10 of a patient’s critical care unit stay is the best policy,” the authors note.