Frontiers in Medicine (Dec 2022)

A U-shaped association of tracheostomy timing with all-cause mortality in mechanically ventilated patients admitted to the intensive care unit: A retrospective cohort study

  • Jing-Ran Chen,
  • Hao-Ran Gao,
  • Yan-Lin Yang,
  • Yan Wang,
  • Yi-Min Zhou,
  • Guang-Qiang Chen,
  • Hong-Liang Li,
  • Linlin Zhang,
  • Jian-Xin Zhou,
  • Jian-Xin Zhou

DOI
https://doi.org/10.3389/fmed.2022.1068569
Journal volume & issue
Vol. 9

Abstract

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ObjectivesTo evaluate the association of tracheostomy timing with all-cause mortality in patients with mechanical ventilation (MV).MethodIt’s a retrospective cohort study. Adult patients undergoing invasive MV who received tracheostomy during the same hospitalization based on the Medical Information Mart for Intensive Care-III (MIMIC-III) database, were selected. The primary outcome was the relationship between tracheostomy timing and 90-day all-cause mortality. A restricted cubic spline was used to analyze the potential non-linear correlation between tracheostomy timing and 90-day all-cause mortality. The secondary outcomes included free days of MV, incidence of ventilator-associated pneumonia (VAP), free days of analgesia/sedation in the intensive care unit (ICU), length of stay (LOS) in the ICU, LOS in hospital, in-ICU mortality, and 30-day all-cause mortality.ResultsA total of 1,209 patients were included in this study, of these, 163 (13.5%) patients underwent tracheostomy within 4 days after intubation, while 647 (53.5%) patients underwent tracheostomy more than 11 days after intubation. The tracheotomy timing showed a U-shaped relationship with all-cause mortality, patients who underwent tracheostomy between 5 and 10 days had the lowest 90-day mortality rate compared with patients who underwent tracheostomy within 4 days and after 11 days [84 (21.1%) vs. 40 (24.5%) and 206 (31.8%), P < 0.001].ConclusionThe tracheotomy timing showed a U-shaped relationship with all-cause mortality, and the risk of mortality was lowest on day 8, but a causal relationship has not been demonstrated.

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