Langenbeck's Archives of Surgery

, Volume 397, Issue 6, pp 1001–1008

Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study

  • Tillo Koch
  • Birgit Hecker
  • Andreas Hecker
  • Florian Brenck
  • Matthias Preuß
  • Thorsten Schmelzer
  • Winfried Padberg
  • Markus A. Weigand
  • Joachim Klasen
Controlled Clinical Trial

DOI: 10.1007/s00423-011-0873-9

Cite this article as:
Koch, T., Hecker, B., Hecker, A. et al. Langenbecks Arch Surg (2012) 397: 1001. doi:10.1007/s00423-011-0873-9

Abstract

Background

Long-term ventilation in intensive care units (ICUs) is associated with several problems such as increased mortality, increased rates of ventilator-associated pneumonia (VAP), and prolonged time of hospitalization, and thus leads to enormous healthcare expenditure. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient’s mortality is still controversial. The aim of our study was to investigate whether early tracheostomy improved outcome in critically ill patients.

Materials and methods

Within 2 years, 100 critically ill, predominantly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy was performed either early (≤4 days, 2.8 days median) or late (≥6 days, 8.1 days median) after intubation.

Results

We could demonstrate that mortality was not significantly reduced in the early tracheostomy (ET) group in contrast to the late tracheostomy (LT) group. ET was associated with decreased VAP incidence (ET 38% vs. LT 64%), decreased duration of ventilation (ET 367.5 h vs LT 507.5 h), and shorter time of hospitalization both in hospital (ET 31.5 days vs LT 68 days) and in ICU (ET 21.5 days vs LT 27 days).

Conclusion

Despite many advantages like reduced time of ventilation and hospitalization, early tracheostomy is not associated with decreased mortality in critically ill patients.

Keywords

Percutaneous dilatational tracheostomyMortalityMechanical ventilationSurgical intensive care unitWeaning

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Tillo Koch
    • 1
  • Birgit Hecker
    • 1
  • Andreas Hecker
    • 2
  • Florian Brenck
    • 1
  • Matthias Preuß
    • 3
  • Thorsten Schmelzer
    • 4
  • Winfried Padberg
    • 2
  • Markus A. Weigand
    • 1
  • Joachim Klasen
    • 5
  1. 1.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital of GießenGießenGermany
  2. 2.Department of General and Thoracic SurgeryUniversity Hospital of GießenGießenGermany
  3. 3.Department of NeurosurgeryUniversity Hospital of GießenGießenGermany
  4. 4.Department of NeurologyUniversity Hospital of GießenGießenGermany
  5. 5.Department of Anaesthesiology and Intensive Care MedicineHospital of KaufbeurenGießenGermany