Objectives
To assess the indications, timing, and clinical outcomes that result from the early
tracheostomy (ET) administration, by causal inference models.
Design
A retrospective observational study.
Setting
Multiinstitutional intensive care unit in the United States
Participants
The study comprised 626 trauma patients.
Interventions
An ET versus late tracheostomy (LT).
Measurements and Main Results
Trauma 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.
Conclusions
The 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.
Key Words
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Article info
Publication history
Published online: December 25, 2022
Publication stage
In Press Corrected ProofFootnotes
This study was supported by The San Hang Program of the Naval Medical University.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
