A COMPARATIVE STUDY OF EARLY AND LATE TRACHEOSTOMY IN PATIENTS ON MECHANICAL VENTILATION IN TERTIARY CARE HOSPITAL
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Abstract
Background:
Aim of the Study: To determine the optimal timing for performing elective Tracheostomy in intensive care unit (ICU) patients. To evaluate the impact of Tracheostomy on clinical outcomes, particularly in reducing the duration of mechanical ventilation and length of hospital stay. To assess the incidence and nature of both early and late complications associated with the procedure.
Materials: 50 patients on mechanical ventilation for varying period ranging from 7 to 25 days were included in the study. The GCS score, indication for Tracheostomy, complications, mean days for decanulation, factors for failed spigotting, one month follow up, hospital stay and duration of stay in ICU were observed and analysed.
Results: Among the 50 patients 52% were operated within 07 days followed by 34% between 08 and 14 days, 12% between 15 and 21 days in 12%. Majority were males and they over represented the study population. The mean GCS on day 3 data was 07 in all the categories except the patients who had undergone Tracheostomy between 15 and 21 days. In the early Tracheostomy group, majority had indication as prolonged ventilation. But majority from the group undergoing procedure between 15 and 21 days had the indication of respiratory failure.
Aim of the Study: To determine the optimal timing for performing elective Tracheostomy in intensive care unit (ICU) patients. To evaluate the impact of Tracheostomy on clinical outcomes, particularly in reducing the duration of mechanical ventilation and length of hospital stay. To assess the incidence and nature of both early and late complications associated with the procedure.
Materials: 50 patients on mechanical ventilation for varying period ranging from 7 to 25 days were included in the study. The GCS score, indication for Tracheostomy, complications, mean days for decanulation, factors for failed spigotting, one month follow up, hospital stay and duration of stay in ICU were observed and analysed.
Results: Among the 50 patients 52% were operated within 07 days followed by 34% between 08 and 14 days, 12% between 15 and 21 days in 12%. Majority were males and they over represented the study population. The mean GCS on day 3 data was 07 in all the categories except the patients who had undergone Tracheostomy between 15 and 21 days. In the early Tracheostomy group, majority had indication as prolonged ventilation. But majority from the group undergoing procedure between 15 and 21 days had the indication of respiratory failure.
Conclusions: Tracheostomy can be carried out as soon as the need for a prolonged Mechanical ventilator support is anticipated. Hence by day 6 to 7 if the patient could not be weaned off from the mechanical ventilator support and extubated, based on the daily weaning assessment and patient’s clinical diagnosis an early elective surgical Tracheostomy for the purpose of Mechanical ventilator support can be planned which will result in a better clinical utcome of the patient undergoing intensive care treatment.
References
1. Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clinics in chest medicine. 2001 Mar 1;22(1):55-69.
2. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta- analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. Bmj. 2005 May 26;330(7502):1243.
3. Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989 Jul 1;96(1):178-81.
4. Ranes JL, Gordon SM, Chen P, Fatica C, Hammel J, Gonzales JP, Arroliga AC. Predictors of long-term mortality in patients with ventilator-associated pneumonia. The American journal of medicine. 2006 Oct 1;119(10):897-e13.
5. Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M. Influence of long-term oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Critical care medicine. 1993 Aug 1;21(8):1132-8.
6. Cavaliere S, Bezzi M, Toninelli C, Foccoli P. Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi archives for chest disease. 2007;67(2).
7. Frutos-Vivar F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, Soto L, Rodrigo C, Raad J, David CM, Matamis D. Outcome of mechanically ventilated patients who require a tracheostomy. Critical care medicine. 2005 Feb 1;33(2):290-8.
8. Durbin CG. Indications for and timing of tracheostomy. Respiratory care.2005 Apr 1;50(4):483-7.
9. Brass P, Hellmich M, Ladra A, Ladra J, Wrzosek A. Percutaneous techniques versus surgical techniques for tracheostomy. Cochrane Database of Systematic Reviews. 2016(7).
10. Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery. 1998 Oct 1;124(4):763-7.
11. Sanabria A, Gómez X, Vega V, Domínguez LC, Osorio C. Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study. Colombia Médica. 2013 Sep;44(3):184-8.
12. Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital. Saudi journal of anaesthesia. 2012 Apr;6(2):152.
13. Charra B, Hachimi A, Benslama A, Motaouakkil S. Tracheotomy versus prolonged intubation in medical intensive care unit patients. Signa vitae: journal for intensive care and emergency medicine. 2009 Apr 1;4(1):21-3.
14. Lanza DC, Decker JW, Koltai PJ, Deng PW, Parnes SM, Fortune JB. Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients. Annals of Otology, Rhinology & Laryngology. 1990 Jan;99(1):38-41.
15. McWhorter AJ. Tracheotomy: timing and techniques. Current opinion in otolaryngology & head and neck surgery. 2003 Dec 1;11(6):473-9.
16. Mohammad Waheed El-Anwar,1 Ahmad Abdel-Fattah Nofal,1 Mohammad A. El Shawadfy,1 Ahmed Maaty,2 and Alaa Omar Khazbak1 for intesive care and emergency medicine. 2009 Apr 1;4(1):21-3.
17. WY, Lew TW, Chin NM, Wong MF. Tracheostomy in a neuro-intensive care setting: indications and timing. Anaesthesia and intensive care. 1997 Aug;25(4):365-8.
18. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Critical Care. 2004 Feb;9(1):1-7.
19. Zheng Y, Feng SU, Chen XK, Zhang GC, Wang XW, Song ZH, Yang SO, Wei LI, Xin XI, Li WX. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chinese medical journal. 2012 Jun 1;125(11):1925-30.
20. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Critical care medicine. 2004 Aug 1;32(8):1689- 94.
21. Bickenbach J, Fries M, Offermanns V, Von Stillfried R, Rossaint R, Marx G, Dembinski R. Impact of early vs. late tracheostomy on weaning: a retrospective analysis. Minerva anestesiologica. 2011 May 26;77(12):1176-83.
22. Jeon YT, Hwang JW, Lim YJ, Lee SY, Woo KI, Park HP. Effect of tracheostomy timing on clinical outcome in neurosurgical patients: early versus late tracheostomy. Journal of neurosurgical anesthesiology. 2014 Jan 1;26(1):22- 6.
23. Mohamed KA, Mousa AY, ElSawy AS, Saleem AM. Early versus late percutaneous tracheostomy in critically ill adult mechanically ventilated patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2014 Apr 1;63(2):443-8.
24. Heffner JE. Tracheotomy application and timing. Clinics in chest medicine. 2003 Sep 1;24(3):389-98.
25. Bouderka MA, Fakhir B, Bouggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004;57:251–4.
26. Wheeler AP, Rice TW. Sepsis in the Acute Respiratory Distress Syndrome: Treatment Implications. InAcute Respiratory Distress Syndrome 2016 Apr 19 (pp. 164-188). CRC Press.
2. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta- analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. Bmj. 2005 May 26;330(7502):1243.
3. Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989 Jul 1;96(1):178-81.
4. Ranes JL, Gordon SM, Chen P, Fatica C, Hammel J, Gonzales JP, Arroliga AC. Predictors of long-term mortality in patients with ventilator-associated pneumonia. The American journal of medicine. 2006 Oct 1;119(10):897-e13.
5. Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, Chaudet M. Influence of long-term oro-or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Critical care medicine. 1993 Aug 1;21(8):1132-8.
6. Cavaliere S, Bezzi M, Toninelli C, Foccoli P. Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi archives for chest disease. 2007;67(2).
7. Frutos-Vivar F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, Soto L, Rodrigo C, Raad J, David CM, Matamis D. Outcome of mechanically ventilated patients who require a tracheostomy. Critical care medicine. 2005 Feb 1;33(2):290-8.
8. Durbin CG. Indications for and timing of tracheostomy. Respiratory care.2005 Apr 1;50(4):483-7.
9. Brass P, Hellmich M, Ladra A, Ladra J, Wrzosek A. Percutaneous techniques versus surgical techniques for tracheostomy. Cochrane Database of Systematic Reviews. 2016(7).
10. Armstrong PA, McCarthy MC, Peoples JB. Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery. 1998 Oct 1;124(4):763-7.
11. Sanabria A, Gómez X, Vega V, Domínguez LC, Osorio C. Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study. Colombia Médica. 2013 Sep;44(3):184-8.
12. Mahafza T, Batarseh S, Bsoul N, Massad E, Qudaisat I, Al-Layla AE. Early vs. late tracheostomy for the ICU patients: Experience in a referral hospital. Saudi journal of anaesthesia. 2012 Apr;6(2):152.
13. Charra B, Hachimi A, Benslama A, Motaouakkil S. Tracheotomy versus prolonged intubation in medical intensive care unit patients. Signa vitae: journal for intensive care and emergency medicine. 2009 Apr 1;4(1):21-3.
14. Lanza DC, Decker JW, Koltai PJ, Deng PW, Parnes SM, Fortune JB. Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients. Annals of Otology, Rhinology & Laryngology. 1990 Jan;99(1):38-41.
15. McWhorter AJ. Tracheotomy: timing and techniques. Current opinion in otolaryngology & head and neck surgery. 2003 Dec 1;11(6):473-9.
16. Mohammad Waheed El-Anwar,1 Ahmad Abdel-Fattah Nofal,1 Mohammad A. El Shawadfy,1 Ahmed Maaty,2 and Alaa Omar Khazbak1 for intesive care and emergency medicine. 2009 Apr 1;4(1):21-3.
17. WY, Lew TW, Chin NM, Wong MF. Tracheostomy in a neuro-intensive care setting: indications and timing. Anaesthesia and intensive care. 1997 Aug;25(4):365-8.
18. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Critical Care. 2004 Feb;9(1):1-7.
19. Zheng Y, Feng SU, Chen XK, Zhang GC, Wang XW, Song ZH, Yang SO, Wei LI, Xin XI, Li WX. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chinese medical journal. 2012 Jun 1;125(11):1925-30.
20. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Critical care medicine. 2004 Aug 1;32(8):1689- 94.
21. Bickenbach J, Fries M, Offermanns V, Von Stillfried R, Rossaint R, Marx G, Dembinski R. Impact of early vs. late tracheostomy on weaning: a retrospective analysis. Minerva anestesiologica. 2011 May 26;77(12):1176-83.
22. Jeon YT, Hwang JW, Lim YJ, Lee SY, Woo KI, Park HP. Effect of tracheostomy timing on clinical outcome in neurosurgical patients: early versus late tracheostomy. Journal of neurosurgical anesthesiology. 2014 Jan 1;26(1):22- 6.
23. Mohamed KA, Mousa AY, ElSawy AS, Saleem AM. Early versus late percutaneous tracheostomy in critically ill adult mechanically ventilated patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2014 Apr 1;63(2):443-8.
24. Heffner JE. Tracheotomy application and timing. Clinics in chest medicine. 2003 Sep 1;24(3):389-98.
25. Bouderka MA, Fakhir B, Bouggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004;57:251–4.
26. Wheeler AP, Rice TW. Sepsis in the Acute Respiratory Distress Syndrome: Treatment Implications. InAcute Respiratory Distress Syndrome 2016 Apr 19 (pp. 164-188). CRC Press.
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May 05, 2025
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Dr. Venkatarathnam Chenumalla, Dr. Pujary Sramalatha, & Dr. Talluri Sree Suguna. (2025). A COMPARATIVE STUDY OF EARLY AND LATE TRACHEOSTOMY IN PATIENTS ON MECHANICAL VENTILATION IN TERTIARY CARE HOSPITAL. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 1162-1171. https://doi.org/10.53555/qdw75b61
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Author Biographies
Dr. Venkatarathnam Chenumalla
Associate Professor of ENT, Department of ENT, Kakatiya Medical College and MGM Hospital, Warangal, Telangana.
Dr. Pujary Sramalatha
Assistant Professor of ENT, Department of ENT, Kakatiya Medical College and MGM Hospital, Warangal, Telangana.
Dr. Talluri Sree Suguna
Senior Resident, Department of ENT, Kakatiya Medical College and MGM Hospital, Warangal, Telangana.
How to Cite
Dr. Venkatarathnam Chenumalla, Dr. Pujary Sramalatha, & Dr. Talluri Sree Suguna. (2025). A COMPARATIVE STUDY OF EARLY AND LATE TRACHEOSTOMY IN PATIENTS ON MECHANICAL VENTILATION IN TERTIARY CARE HOSPITAL. Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 1162-1171. https://doi.org/10.53555/qdw75b61