Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Comparison of Extubation vs Tracheostomy in Patients Ventilated for at Least 14 Days: A Retrospective Observational Study

Ameer Said, Inbal D Elisha, Gingy R Balmor, Nadav Navo, Adam Laytin, Roman Rysin, Katia Dayan, Mordechai Shimonov

Keywords : Critical care, Late extubation, Late tracheostomy, Mechanical ventilation

Citation Information : Said A, Elisha ID, Balmor GR, Navo N, Laytin A, Rysin R, Dayan K, Shimonov M. Comparison of Extubation vs Tracheostomy in Patients Ventilated for at Least 14 Days: A Retrospective Observational Study. Panam J Trauma Crit Care Emerg Surg 2023; 12 (3):110-115.

DOI: 10.5005/jp-journals-10030-1429

License: CC BY-NC 4.0

Published Online: 30-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aims and background: Prolonged mechanical ventilation is frequently required in severely ill patients. The goal of the study is to describe the outcomes of critically ill patients who are mechanically ventilated for >14 days and the effect of late tracheostomy vs late extubation on their outcome. Patients and methods: A retrospective descriptive study was conducted at a single intensive care unit (ICU) at an academic tertiary medical center. All patients were admitted to the ICU on mechanical ventilation for >14 days over a 5-year period (1st January 2016–31st December 2020). The main outcome measures analyzed were length of ICU stay and inhospital mortality. Results: A total of 179 patients were hospitalized in the ICU for >14 days. Of these, 36 were mechanically ventilated for greater than 14 days, 26 of them eventually underwent a tracheostomy, and 10 were extubated. As compared to the extubated patients, the cohort receiving the tracheostomy all had significantly longer ICU lengths of stay (27 vs 47.5 days, p-value 0.0017), length of hospitalization (29.5 vs 52 days, p-value < 0.05), and total days of mechanical ventilation (21.5 vs 46 days, p-value < 0.05). There was no significant difference between the days of endotracheal (ET) intubation, ventilator-associated pneumonia (VAP), albumin (Alb) and hemoglobin (Hb) levels, ICU death, or discharge. Undergoing tracheostomy resulted in a longer ICU/hospitalization without a change in overall inhospital mortality. Conclusion: Performing late tracheostomy after 14 days may prolong hospitalization without improving inhospital survival. Clinical significance: All efforts should be made to determine the need for, and subsequently perform, a tracheostomy. For whatever reasons, this is delayed beyond 14 days, the team should reevaluate the benefit to the patient and potential for possible ET extubation from mechanical ventilation.

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