Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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

ORIGINAL RESEARCH

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

Adam L Goldstein, Ameer Said, Inbal D Elisha, Ronit Bar-Haim, Gingy R Balmor, Nadav Navo, Adam Laytin, Roman Rysin, Katia Dayan, Mordechai Shimonov, Rijini Nugzar, Arie Soroksky

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

Citation Information : Goldstein AL, Said A, Elisha ID, Bar-Haim R, Balmor GR, Navo N, Laytin A, Rysin R, Dayan K, Shimonov M, Nugzar R, Soroksky A. 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).


Abstract

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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