Early tracheostomy yields mortality benefit in mechanically ventilated patients with COPD

Early tracheostomy within 9 days of mechanical ventilation was associated with lower 90-day mortality and hospital length of stay compared with late tracheostomy in patients with COPD, according to results of a retrospective study.

“A lot of studies have been done before looking for the best time to perform this procedure in critically ill patients. However, the results are inconclusive and few of those studies consider the subgroup [of] COPD,” Yahia Mohamed, MD, PhD student in the department of biomedical and health informatics at the University of Missouri-Kansas City, said during a presentation at the virtual CHEST Annual Meeting. “Our objective in this study was to describe the contemporary population of COPD in the ICU and to compare the impact of tracheostomy on [this] subgroup.”

The retrospective analysis included 1,728 mechanically ventilated patients with COPD who underwent tracheostomy from 2009 to June 2018. Patients were categorized into groups based on timing of tracheostomy: the early group (n = 617) underwent tracheostomy before the ninth day of mechanical ventilation and the late group (n = 1,111) underwent tracheostomy after 9 days of mechanical ventilation.

In the early tracheostomy group, 90-day all-cause in-hospital mortality was 15.24% compared with 22.41% in the late tracheostomy group (OR = 0.632; 95% CI, 0.485-0.823; P = .0006).

The early tracheostomy group had higher tracheostomy-related complications with 6.16% compared with 4.5% in the late tracheostomy group (OR = 1.62; 95% CI, 1.041-2.523; P = .0326).

Hospital length of stay was shorter in the early tracheostomy group, with a median of 19 days compared with 29 days in the late tracheostomy group (OR = 0.709; 95% CI, 0.669-0.743; P < .001).

Aspiration pneumonitis risk was not significantly different between the groups (OR = 0.771; 95% CI, 0.588-1.01; P = .059).

Limitations of this study include its retrospective design, inability to define the duration of mechanical ventilation or ICU length of stay and inability to answer why the early tracheostomy group had a higher rate of complications, Mohamed said.

“This study will advance knowledge regrading this controversial topic and provide information about the usual care provided in U.S. hospitals for this subgroup of patients. The study results may guide physicians in making care decisions,” the researchers wrote in the abstract.

Reference:

Mohamed Y, et al. Chest. 2020;doi:10.1016/j.chest.2020.08.1507.