TY - JOUR
T1 - Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients
AU - Freeman, Bradley D.
AU - Borecki, Ingrid B.
AU - Coopersmith, Craig M.
AU - Buchman, Timothy G.
N1 - Funding Information:
We greatly appreciate the assistance provided by Maureen Stark, Meg Wilson, and Tracy Haidar of the Cerner corporation in preparation of the Project Impact database for analysis.
PY - 2005/11
Y1 - 2005/11
N2 - Objective: Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking. We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice. Design: Analysis of Project Impact, a multi-institutional critical care administrative database. Setting: Medical school. Patients: Data from 43,916 patients were reviewed. Interventions: None. Measurements and Main Results: Tracheostomy was performed in 2,473 (5.6%) of 43,916 patients analyzed. Tracheostomy patients had a higher survival rate than nontracheostomy patients (78.1 vs. 71.7%, p < .001) and underwent this procedure following a median (25th-75th percentile) of 9.0 (5.0-14.0) days of ventilatory support. Tracheostomy frequency and timing varied significantly comparing patient, intensive care unit, and hospital characteristics (p < .05 for all). Tracheostomy timing correlated significantly with duration of mechanical ventilation (r = .690), intensive care unit (r = .610), and hospital length of stay (r = .341, p < .001 for all). At most, 22% of patients were supported via tracheostomy at any given time. Although a minority, tracheostomy patients accounted for 26.2%, 21.0%, and 13.5% of all ventilator, intensive care unit, and hospital days, respectively. Conclusions: Although practice varies substantially, tracheostomy timing appears significantly associated with duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay. These findings emphasize the need for an adequately supported multiple-center trial to better define patient selection for tracheostomy and to test the hypothesis that timing of this procedure influences clinically important outcomes.
AB - Objective: Tracheostomy practice in the setting of critical illness is controversial because evidence demonstrating unequivocal benefit is lacking. We undertook this study to determine the relationship between tracheostomy timing and duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay and to evaluate the relative influence of clinical and nonclinical factors on tracheostomy practice. Design: Analysis of Project Impact, a multi-institutional critical care administrative database. Setting: Medical school. Patients: Data from 43,916 patients were reviewed. Interventions: None. Measurements and Main Results: Tracheostomy was performed in 2,473 (5.6%) of 43,916 patients analyzed. Tracheostomy patients had a higher survival rate than nontracheostomy patients (78.1 vs. 71.7%, p < .001) and underwent this procedure following a median (25th-75th percentile) of 9.0 (5.0-14.0) days of ventilatory support. Tracheostomy frequency and timing varied significantly comparing patient, intensive care unit, and hospital characteristics (p < .05 for all). Tracheostomy timing correlated significantly with duration of mechanical ventilation (r = .690), intensive care unit (r = .610), and hospital length of stay (r = .341, p < .001 for all). At most, 22% of patients were supported via tracheostomy at any given time. Although a minority, tracheostomy patients accounted for 26.2%, 21.0%, and 13.5% of all ventilator, intensive care unit, and hospital days, respectively. Conclusions: Although practice varies substantially, tracheostomy timing appears significantly associated with duration of mechanical ventilation, intensive care unit length of stay, and hospital length of stay. These findings emphasize the need for an adequately supported multiple-center trial to better define patient selection for tracheostomy and to test the hypothesis that timing of this procedure influences clinically important outcomes.
KW - Artificial respiration
KW - Health expenditures
KW - Outcome assessment
KW - Physician's practice patterns
KW - Respiratory insufficiency
KW - Tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=27944436551&partnerID=8YFLogxK
U2 - 10.1097/01.CCM.0000186369.91799.44
DO - 10.1097/01.CCM.0000186369.91799.44
M3 - Article
C2 - 16276175
AN - SCOPUS:27944436551
SN - 0090-3493
VL - 33
SP - 2513
EP - 2520
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 11
ER -