• Chi Peng, Liwei Peng, Fan Yang, Hang Yu, Peng Wang, Chao Cheng, Wei Zuo, Weixin Li, and Zhichao Jin.
• Department of Health Statistics, Naval Medical University, Shanghai, China.
• J. Cardiothorac. Vasc. Anesth. 2023 Dec 1; 37 (12): 258425912584-2591.

ObjectivesTo assess the indications, timing, and clinical outcomes that result from the early tracheostomy (ET) administration, by causal inference models.DesignA retrospective observational study.SettingMultiinstitutional intensive care unit in the United States PARTICIPANTS: The study comprised 626 trauma patients.InterventionsAn ET versus late tracheostomy (LT).Measurements And Main ResultsTrauma patients with tracheostomy were identified from 2 public databases named Medical Information Mart for the Intensive Care-IV and eICU Collaborative Research Database. Tracheostomy was defined as early (≤7 days) or late (>7 days) from intensive care unit admission. A marginal structural Cox model (MSCM) with inverse probability weighting was employed. For comparison, the authors also used time-dependent propensity-score matching (PSM) to account for differences in the probability of receiving an ET or LT. A total of 626 eligible patients were enrolled in the study, of whom 321 (51%) received a ET. The MSCM and time-dependent PSM indicated that the ET group was associated with reduced ventilation-associated pneumonia (VAP) and a shorter mechanical ventilation (MV) duration than the LT group. Yet, mortality did not show any difference between the two groups.ConclusionsThe authors' study observed that ET was not associated with reduced mortality in trauma patients, but it was associated with reduced VAP risk and MV duration. The results warrant further validation in randomized controlled trials.Copyright © 2022 Elsevier Inc. All rights reserved.

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