Epidemiology, timing, technique, and outcomes of tracheostomy in patients with trauma: a multi-centre retrospective study

Background: Tracheostomy is performed in patients with trauma who need prolonged ventilation for respiratory failure or airway management. Although it has benefits, such as reduced sedation and easier care, it also has risks. This study explored the unclear timing, technique, and patient selection criteria for tracheostomy in patients with trauma.

Methods: We included 220 adult patients with trauma who underwent tracheostomy after endotracheal intubation between January 2019 and December 2022. We compared clinical outcomes between patients who underwent early (within 10 days) and late (after 10 days) tracheostomy and between patients who underwent percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST). Factors associated with hospital and intensive care unit (ICU) length of stay (LOS), ICU-free days, duration of mechanical ventilation, and ventilator-free days (VFDs) were identified using multiple linear regression analysis.

Results: The patients' mean age was 61.5 years; 75.9% were men. Most tracheostomies were performed after 10 days (n = 135, 61.4%), with PDT serving as the more common approach during this period. Contrastingly, early tracheostomies (n = 85, 38.6%) were predominantly performed using ST. Early tracheostomy was significantly associated with reduced hospital (P = 0.038) and ICU LOS (P = 0.047), decreased duration of mechanical ventilation (P = 0.001), and increased VFDs (P < 0.001). However, no significant association was found with ICU-free days (P = 0.072) or in-hospital mortality (P = 0.917).

Conclusion: Early tracheostomy was associated with reduced hospital and ICU LOS, decreased duration of mechanical ventilation, and increased VFDs.