Tracheostomy timing and weaning outcomes following prolonged mechanical ventilation

Controversy exists on the optimal timing for performing a tracheostomy in critically ill patients, particularly in terms of clinical outcomes such as weaning failures, mechanical ventilation duration, ventilator-associated pneumonia, and mortality. The present study aimed to determine whether prolonged mechanically ventilated patients had a higher success rate in ventilator weaning after an “early” tracheostomy”, defined as ≤ 14 days following endotracheal intubation. An observational, retrospective single-center study of 738 prolonged ventilated, tracheotomized patients treated at a national weaning center over 12 years. Propensity score matching and binary logistic regression analysis were used to evaluate whether an early tracheostomy independently predicted prolonged weaning failures, defined as the transition to home mechanical ventilation. The entire cohort comprised 507 early procedures (69%), and propensity score matching yielded 220 patients in each group undergoing either an early or a late tracheostomy. Prolonged weaning failure rates (34% vs. 33%, P = 0.762) and other secondary outcomes – decannulation failures, frequencies of long-term oxygen therapy at hospital discharge, mortality rates – were not different between these groups, and an early tracheostomy was not independently associated with failure to wean in logistic regression analysis. However, the groups differed significantly in the total duration of mechanical ventilation (40 days IQR 32–56 vs. 51 days 52–70, P < 0.01), primarily due to the additional days spent on ventilators before admission to the weaning center in cases of late tracheostomy. No significant difference in weaning failure rates or other secondary outcomes was observed among prolonged mechanically ventilated, tracheotomized patients treated at a specialized facility, regardless of early (≤ 14 days) or late tracheostomy.