Association Between Early Tracheostomy and Patient Outcomes in Critically Ill Patients on Mechanical Ventilator: A Retrospective Cohort Study رسالة ماجستير

Abstract

Background: Tracheostomy is a common intervention for critically ill patients, often recommended to avoid the complications associated with prolonged intubation, such as longer ventilation periods and extended hospital stays. Despite these benefits, its effect on mortality rates is not well established. This study investigates the relationship between the timing of tracheostomy and patient outcomes, specifically focusing on mortality in a cohort of ventilated ICU patients. Methods: the researcher performed a retrospective cohort study using data from the Japan Intensive Care Patient Database, encompassing adult ICU patients who underwent tracheostomy between January 2021 and July 2023. Patients were excluded if their tracheostomy occurred within 29 days of ICU admission to focus on those with more prolonged intubation. The primary outcomes of interest were hospital and ICU mortality rates. The patients were stratified into quartiles based on the timing of their tracheostomy: Q1 (≤6 days), Q2 (7-14 days), Q3 (15-22 days), and Q4 (>22 days). Regression analyses were conducted to evaluate the association between tracheostomy timing and mortality, adjusting for potential confounders. Results: Our analysis included 60 ICU patients. The data revealed that hospital mortality rates increased with the delay in tracheostomy. Specifically, mortality rates were 5.9% in Q1, 12.5% in Q2, 28.6% in Q3, and 30.77% in Q4, with a significant trend (P=0.001). The adjusted odds ratio for mortality in Q4 compared to Q1 was 3.04 (95% CI: 0.22–40.82), indicating a significantly higher risk in later tracheostomy quartiles. Subgroup analyses focusing on patients with respiratory failure and reduced awareness upon ICU admission

V revealed similar trends. However, no significant differences were observed in other parameters of interest (P>0.05). Conclusion: This study provides evidence of a significant independent association between the timing of tracheostomy and both hospital and ICU mortality rates. Early tracheostomy appears to be linked with improved outcomes, suggesting a potential benefit in reducing mortality. The results highlight a gradient effect, with varying levels of mortality risk associated with different timings of the procedure. These findings underscore the importance of considering timing in the management of critically ill patients and may inform clinical decision-making to optimize patient outcomes