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Early Tracheostomy Reduces Sedative Use but Does Not Affect Mortality: Presented at ISICEM By Evelyn Harvey BRUSSELS, Belgium -- March 26, 2009 -- Performing an early tracheostomy 1 to 4 days following admission to intensive care unit (ICU) significantly reduces sedative use, researchers stated here at the 29th International Symposium on Intensive Care and Emergency Medicine (ISICEM). However, the study also found that early tracheostomy does not appear to affect short- or long-term mortality rates. "Many clinicians believe early tracheostomy benefits patients, but more trial data were needed," said lead author Duncan Young, MD, John Radcliffe Hospital, Oxford, United Kingdom, at a presentation on March 25. "We hypothesised that placing a tracheostomy at days 1 to 4 reduces 30-day mortality compared to day 10 or later." The study included 909 patients from 87 UK hospitals who were expected to stay 7 days or more in the ICU. Patients were randomised to receive early (n = 455) or deferred (n = 454) tracheostomy. Patient characteristics were similar across both groups, with respiratory failure the most common cause of admission to the ICU. The majority of tracheostomies (89%) were bedside percutaneous procedures, and 71% were performed with single tapered dilator. Surgical tracheostomy was performed in 10% of patients. Procedural complications such as bleeding were infrequent (6.3%), and no serious adverse events were recorded. The majority (93.1%) of the early group had tracheostomies within 4 days. Fewer patients in the deferred group required tracheostomies (45.5%); however, these were performed on or after day 10. Of those who did not require tracheostomy, 36.5% were discharged from the ICU, 32% were extubated, and 22.1% died. There were no significant differences in 30-day mortality between the early and deferred tracheostomy groups (139 vs 141 deaths) or at 2 years post randomisation (74% follow-up). Tracheostomy timing did not affect the duration of ICU care or hospital stay in survivors or nonsurvivors. There were no significant changes in antibiotic use, but mean days sedation fell significantly in the early group, to 6.6 days compared with 9.3 days in the deferred group. "If you had 100 patients requiring tracheostomy, doing it early results in 2.4 days less sedation overall, but you would perform 48 more, with 3 more procedural complications, and no effect on mortality or ICU length of stay," said Dr. Young, putting the results into the clinical perspective. Studies of tracheostomy timing may be confounded by the decreased likelihood of tracheostomy requirement at 10 days, due to death or extubation. Further studies may need to shift their focus from mortality to the effects of early tracheostomy on patient care and interventions, such as ventilation, in more detail to discern whether it benefits patients. Funding for this study was provided by the UK Medical Research Council as part of the UK Clinical Research Network Portfolio. [Presentation title: Early vs Late Tracheostomy: The TracMan Trial.] E-mail this page to a friend or colleague! To print, use this version