Early Tracheostomy in Trauma patients?

Background:  The influence of tracheostomy timing on outcome after severe head injury remains controversial.

Methods: The investigation was based on data prospectively collected by the Pennsylvania Trauma Society Foundation statewide trauma registry from January 1990 until December 2005.

Results: 3,104 patients met criteria for inclusion in the study (GCS less than/= 8 and tracheostomy). Early Tracheostomy Group (ETG) patients, defined as tracheostomy performed during hospital days 1–7, were more likely to be functionally independent at discharge (adjusted odds ratio (OR) 1.45, 95% confidence interval (CI), 1.16–1.82, P = 0.001) and have a shorter length of stay (adjusted OR 0.23, 95% CI, 0.20–0.28, P less than 0.0001). However, Late Tracheostomy Group (LTG) patients, defined as tracheostomy performed  more than 7 days after admission, were approximately twice as likely to be discharged alive (adjusted OR 2.12, 95% CI, 1.60–2.82, P less than 0.0001). Using a Composite Outcome Scale, which combined these three measures, there was a non-significant trend toward a higher likelihood of a poor outcome in LTG patients. When this analysis was repeated using only those patients in relatively good condition on admission, LTG patients were found to be approximately 50% less likely to have a good outcome (adjusted OR 0.46, 95% CI, 0.28–0.73, P = 0.001) when compared to ETG patients.

Conclusions: These results indicate a complex relationship between tracheostomy timing and outcome, but suggest that a strategy of early tracheostomy, particularly when performed on patients with a reasonable chance of survival, results in a better overall clinical outcome than when the tracheostomy is performed in a delayed manner.

Impact of Tracheostomy Timing on Outcome After Severe Head Injury  - Neurocritical Care, DOI: 10.1007/s12028-011-9615-7 (online first)