• Tillo Koch, Birgit Hecker, Andreas Hecker, Florian Brenck, Matthias Preuß, Thorsten Schmelzer, Winfried Padberg, Markus A Weigand, and Joachim Klasen.
• Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Gießen, Rudolf-Buchheim-Straße 7, Gießen, Germany.
• Langenbecks Arch Surg. 2012 Aug 1;397(6):1001-8.

BackgroundLong-term ventilation in intensive care units (ICUs) is associated with several problems such as increased mortality, increased rates of ventilator-associated pneumonia (VAP), and prolonged time of hospitalization, and thus leads to enormous healthcare expenditure. While the influence of tracheostomy on VAP incidence, duration of ventilation, and time of hospitalization has already been analyzed in several studies, the timing of the tracheostomy procedure on patient's mortality is still controversial. The aim of our study was to investigate whether early tracheostomy improved outcome in critically ill patients.Materials And MethodsWithin 2 years, 100 critically ill, predominantly surgical patients entered this prospective randomized study. A percutaneous dilatational tracheostomy was performed either early (≤4 days, 2.8 days median) or late (≥6 days, 8.1 days median) after intubation.ResultsWe could demonstrate that mortality was not significantly reduced in the early tracheostomy (ET) group in contrast to the late tracheostomy (LT) group. ET was associated with decreased VAP incidence (ET 38% vs. LT 64%), decreased duration of ventilation (ET 367.5 h vs LT 507.5 h), and shorter time of hospitalization both in hospital (ET 31.5 days vs LT 68 days) and in ICU (ET 21.5 days vs LT 27 days).ConclusionDespite many advantages like reduced time of ventilation and hospitalization, early tracheostomy is not associated with decreased mortality in critically ill patients.

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