In a Cochrane review that included eight randomized, controlled trials and 1,977 patients, early conversion to tracheostomy after 10 days or fewer of ventilation performed better than later tracheostomy (Cochrane Database Syst Rev. 2015;1:CD007271). The risk of overall mortality was 17% lower in the early group, and the use of care in the intensive care unit decreased, although that review couldn’t reach conclusions about ventilator-associated pneumonia or laryngotracheal injury because of the heterogeneity of the patients studied, Dr. Damrose said.
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June 2022In addition, in a meta-analysis, early transition—this time defined as within two to eight days of intubation—led to a shorter intensive care unit stay, lowered the incidence of pneumonia, and lowered the duration of ventilation support, he said (Otolaryngol Head Neck Surg. 2015;152:219-227).
The best practice message to take from the literature, Dr. Damrose said, is that the upper limit of conversion to tracheostomy should be about 10 days. “If you can tracheotomize these folks within that window, there’s generally an overall improvement in mortality and a decreased utilization of ICU care,” he said.
The literature also shows the importance of taking obesity into account, he added. “Certain subpopulations, especially the morbidly obese and those (with large tubes), may also benefit from early tracheotomy to decrease the risk of laryngotracheal injury.”
Thomas R. Collins is a freelance medical writer based in Florida.