Background: The timing of tracheostomy in the intensive care unit (ICU) is debated because of its potential effects on comfort, sedation management, and ventilator weaning. Objective: To compare early (≤10 days) versus late (>10 days) tracheostomy with respect to discontinuation of sedation and invasive ventilation. Methods: Single-centre retrospective observational study. We included 52 consecutive ICU patients who underwent tracheostomy (January 2023–June 2025): 16 early and 36 late. Switching to dexmedetomidine was considered discontinuation of hypnotic sedation; transition to home mechanical ventilation (VAM) was considered discontinuation of invasive ventilation. Results: Sedation discontinuation occurred in 15/16 (93.8%) early vs. 35/36 (97.2%) late patients (p = 0.525). Discontinuation of invasive ventilation occurred in 12/16 (75.0%) early vs. 31/36 (86.1%) late patients (p = 0.431). Tracheostomy-to-sedation stop time: median 3 days IQR 1–10 (overlapping between groups). Tracheostomy-to-ventilation stop time: median 17 days IQR 10–27 (17 11–33 early vs. 17 10–25 late). ICU mortality: 3/16 (18.8%) vs. 6/36 (16.7%) (p = 1.00). Conclusions: In this retrospective cohort, no statistically significant differences emerged between early and late tracheostomy regarding discontinuation of sedation or invasive ventilation. However, given the retrospective design and small sample size, the study may have been underpowered to detect smaller but clinically relevant differences between groups. Prospective studies with larger sample sizes and severity-related variables may clarify any effects of timing.
Buglione et al. (Tue,) studied this question.