Olton S, Hariharan S, Chen D
Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Trinidad and Tobago.
West Indian Med J. 2009 Mar;58(2):173-8.
To evaluate the outcome of patients who have undergone a tracheostomy in a multidisciplinary intensive care unit (ICU) and to determine the difference between an early and late tracheostomy.
All patients who had tracheostomy in the ICU of The Eric Williams Medical Sciences Complex, Trinidad and Tobago, over a five-year period were retrospectively analysed. Data recorded included demographics, admission diagnoses, Glasgow Coma Score, Acute Physiology and Chronic Health Evaluation II score, Paediatric Index of Mortality II score, indication for endotracheal intubation and tracheostomy and the day it was performed, ICU and hospital length of stay and observed mortality. Predicted mortality was calculated. A comparison was made of patients who had tracheostomy before and after ten days following ICU admission. Validation of the prognostic models was done by Receiver Operating Curve (ROC) analysis.
One thousand six-hundred and fourteen patients were admitted to ICU during the study period; 51 patients (3%) underwent tracheostomy, of which 48 were studied. The overall mortality was 19.1% and 40.6% in tracheostomised patients. Patients who had tracheostomy within ten days had a significantly lesser predicted mortality and shorter ICU length of stay than those who had it after ten days (p = 0.01). The observed mortality was also significantly less in early-tracheostomised patients (p < 0.02).
Tracheostomy should ideally be done within ten days following ICU admission when there is a clear need and indication for the procedure. Further delay may contribute adversely to the ICU morbidity and mortality.
