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No benefit from early tracheotomy in mechanically ventilated ICU patients?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3582 (Published 04 June 2013) Cite this as: BMJ 2013;346:f3582

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Previous evidence suggested early tracheotomy may save lives and shorten hospital stay for people who receive mechanical ventilation in an intensive care unit (ICU). But a recent open label trial from 72 UK hospitals does not confirm this.

A total of 909 patients participated. All were receiving mechanical ventilation for four days or less when doctors identified them as likely to require mechanical ventilation for at least seven more days. They were then randomised to receive tracheotomy immediately or to a wait-and-see strategy, where the decision was delayed to at least 10 days after ventilation was initiated and tracheotomy was performed only if still indicated.

In the early tracheotomy group, 85% (385/455) received tracheotomy as allocated, whereas in the other group only 45% (204/454) ever received one; two thirds of the others didn’t need one because they had recovered, didn’t need mechanical ventilation any more, or had already been discharged from the unit alive.

No difference between the groups was seen in all cause mortality (at 30 days after randomisation, at critical unit and hospital discharge, and at one and two years), length of stay in the unit and in an acute hospital, or days without antibiotic use up to 30 days from randomisation (as a proxy for hospital acquired infections).

The only difference between the groups was in the use of sedatives, which were used for a median of five days in the early tracheotomy group (interquartile range three to nine) and for nine days in the delayed tracheotomy group (four to 12; P<0.001).

Notes

Cite this as: BMJ 2013;346:f3582