Timing of Tracheostomy as a Determinant of Weaning Success in Critically

Ill Patients: A Retrospective Study

Isakovich B. MD, **Dimitrov D. MD, *Litmanovitch M. MD*

General ICU Hyllel Yaffe Medical Center Hadera Israel*
Surgical Department "A" Hyllel Yaffe Medical Center Hadera Israel**

Abstract

Introduction: Tracheostomy is frequently performed in critically ill patients for

prolonged intubation. However, the optimal timing of tracheostomy, and its
impact on weaning from mechanical ventilation and outcomes in critically ill
.patients who require mechanical ventilation remain controversial

Methods: The medical records of patients who underwent tracheostomy in the

general critical care unit (ICU) of a tertiary medical centre from January 2001 to
December 2005 were reviewed. Clinical characteristics, length of stay in the ICU,
rates of post-tracheostomy pneumonia, weaning from mechanical ventilation and
.mortality rates were analyzed

:Results

A total of 113 patients (68 men and 45 women) were included; their mean age
was 73.4 years. Patients were classified into two groups: successful weaning ( n =
47) and failure to wean ( n = 66). Shorter intubation periods before performed
tracheostomy ( P = 0.02), length of ICU stay ( P = 0.001) and post-tracheostomy
ICU stay ( P = 0.005) were noted in patients in the successful weaning group.
Patients who underwent tracheostomy more than 12 days after intubation had
.higher ICU mortality rates and rates of weaning failure

Outcomes Total Successful Failure to P

(n = 113) weaning (n = wean (n =
47) 66)
ICU mortality (n [%]) 22 6 (5.4%) 18 (15.9%) <0.001
(19.4%)
In-hospital mortality 58 15 (13.2%) 43 (38.1%) <0.001
total (n [%])(+ ICU) (51.4%)
Intubation period 19.5 ± 16.3 ± 10.5 20.4 ± 10.9 0.02
(days) 8.9
Overall ICU stay (days) 19.7 ± 15.4 ± 10.8 22.7 ± 6.4 0.001
8.2
Post-tracheostomy ICU 8.9 ± 9.9 6.5 ± 7.6 13.0 ± 8.3 0.005
stay (days)
Post-tracheostomy 32 12 (10.6%) 20 (27.5%) 0.006
pneumonia (28.5%)

The length of intubation correlated with the length of ICU stay in the successful
weaning group (r = 0.70; P < 0.001). Multivariate analysis revealed that
tracheostomy after 12 days of intubation, poor oxygenation before tracheostomy
(arterial oxygen tension/fractional inspired oxygen ratio <250) and occurrence of
.pneumonia after tracheostomy were independent predictors of weaning failure

Conclusion: The study suggests that tracheostomy after 12 days of intubation is

associated with a higher rate of failure to wean from mechanical ventilation,
.longer ICU stay and higher ICU mortality