Authors
Idris Chikophe
Third Author
Keywords
Early tracheostomy
Mechanical ventilation
Critical illness
Introduction
Tracheostomy is frequently performed for patients who have critical illness and are deemed to require prolonged durations of mechanical ventilation. Despite demonstrable benefits, optimal timing for the insertion of a tracheostomy remains debated.
Evidence from low- and middle-income countries (LMICs) is scarce, and findings from high-resource settings may not be generalizable to resource-constrained intensive care units (ICUs).
Objectives
To determine the difference in length of ICU stay between early tracheostomy (ET; performed within 10 days of mechanical ventilation) and late tracheostomy (LT; performed after 10 days) at AKUHN.
Methods
An observational retrospective cohort study with utilization of propensity score matching (PSM). All patients who underwent tracheostomy at AKUHN between January 2015 and July 2025 were screened. The primary outcome was length of ICU stay. The secondary outcomes were hospital LOS, duration of mechanical ventilation, tracheostomy-related complications and 30-day mortality.
Results
The ET group had a shorter ICU stay than the LT group (19 vs 25.5 days). Duration of mechanical ventilation was also lower (14 vs 21.5 days). Hospital stay was similar (38.5 vs 45.5 days). Thirty-day mortality was lower in the ET group (15% vs 28%).
Discussion
Early tracheostomy was associated with reduced duration of mechanical ventilation and shorter ICU stay, suggesting improved efficiency in critical care management. Although hospital stay and 30-day mortality were lower in the early group, these differences were not statistically significant. These findings support early tracheostomy as beneficial, though larger studies are needed to confirm its impact on survival outcomes.
Conclusion
In resource-constrained ICU settings where bed availability is a limiting factor, early tracheostomy may improve bed turnover and optimize critical care resource utilization. The results support consideration of structured early tracheostomy protocols for patients anticipated to require prolonged ventilatory support.
References
(Young et al 2013) the TracMan randomized trial.
Meng, et al. (2016) Early vs late tracheostomy in critically ill patients
