Mark D. Soth, MD
In patients ventilated for acute respiratory failure, does early tracheotomy reduce ventilator-associated pneumonia (VAP) compared with late tracheotomy?
Randomized controlled trial. ClincialTrials.gov NCT00262431.
Blinded (assessors of nonobjective components of Clinical Pulmonary Infection Score [CPIS]).*
28 days from randomization.
12 intensive care units (ICUs) in Italy.
419 patients > 18 years of age (mean age 62 y, 67% men) who had been mechanically ventilated for acute respiratory failure for 72 hours and had a Simplified Acute Physiology Score II between 35 and 65. Exclusion criteria included sequential organ failure assessment score < 5; improvement in respiratory condition eliminating the need for mechanical ventilation (PaO2 > 60 mm Hg, FIO2 < 0.5, positive end-expiratory pressure < 8 cm H2O); moribund state; CPIS > 6; chronic obstructive pulmonary disease; anatomical deformity of the neck; cervical tumors; history of esophageal, tracheal, or pulmonary cancer; previous tracheotomy; soft tissue infection of the neck; hematologic cancer; and pregnancy.
Tracheotomy after 6 to 8 days (early group; n = 209) or after 13 to 15 days (late group; n = 210) of endotracheal intubation.
VAP. Secondary outcomes included remaining on ventilator, remaining in ICU, and mortality.
100% (intention-to-treat analysis).
Many patients did not receive tracheotomies (31% of the early group and 43% of the late group, respectively). Early and late tracheotomy did not differ for VAP or mortality at 28 days (Table). Early tracheotomy reduced the risk for remaining ventilated or remaining in the ICU (Table).
In ventilated patients with acute respiratory failure, early tracheotomy did not reduce ventilator-associated pneumonia compared with late tracheotomy.
Early vs late tracheotomy in patients ventilated for acute respiratory failure†
†Abbreviations defined in Glossary. RRR, NNT, and CI calculated from control event rates and hazard ratios in article.
Soth MD. Early tracheotomy did not reduce ventilator-associated pneumonia in adults ventilated for acute respiratory failure. Ann Intern Med. ;153:JC2–9. doi: 10.7326/0003-4819-153-4-201008170-02009
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Published: Ann Intern Med. 2010;153(4):JC2-9.
Mechanical Ventilation, Pulmonary/Critical Care.
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