Abstract Rationale Tracheostomy is common in critically ill burn patients who require prolonged mechanical ventilation, yet the optimal timing remains uncertain. Early tracheostomy (≤10 days from intubation) may reduce sedation exposure and ventilator-associated complications; however, evidence specific to burn populations is scarce. This study aimed to determine whether early tracheostomy is associated with improved survival and functional outcomes in severely burned intensive care unit (ICU) patients. Methods We conducted a retrospective cohort study at Fundación Santa Fe de Bogotá between June 2021 and July 2025. Patients were categorized as early tracheostomy (≤10 days after orotracheal intubation) or late tracheostomy (10 days). Primary outcomes included 180-day all-cause mortality and duration of invasive mechanical ventilation. Secondary outcomes were ICU and hospital length of stay, ventilator-associated pneumonia (VAP), and tracheostomy-related complications. An analysis of covariance (ANCOVA) was used to adjust for baseline functional status, measured by the Johns Hopkins Highest Level of Mobility scale at ICU admission. Results Forty-two burn patients were included: 34 underwent early tracheostomy and 8 late tracheostomy. Baseline characteristics were comparable between groups. Airway burn was the predominant indication among early cases (30/34, 88%) but absent in the late group. Early tracheostomy patients required fewer days of vasopressors (mean 6 ± 8 vs. 12 ± 5; p = 0.009). Duration of invasive ventilation was similar (median 16 vs. 16 days; p 0.9). ICU stay was longer in the early group (mean 33 ± 23 vs. 22 ± 13 days; p = 0.045), while hospital stay showed no significant difference. VAP occurred in 26% of early and 12.5% of late tracheostomy patients (p = 0.4). Complications were rare: no surgical-site infections and one minor bleeding episode (2.9%) in the early group. Mortality at 180 days was significantly lower with early tracheostomy (3/34, 8.8%) than with late tracheostomy (5/8, 63%; p = 0.003). In the ANCOVA model, early tracheostomy remained independently associated with better functional outcomes (difference = 3.17 points; 95% CI, 1.6-4.8; p = 0.0003). Conclusions In this single-center burn ICU cohort, early tracheostomy (≤10 days) was associated with markedly lower 180-day mortality and improved functional recovery, suggesting that timely airway management may facilitate earlier rehabilitation without reducing ventilator duration. Although early tracheostomy was linked to longer ICU stay, no increase in complications was observed. This abstract is funded by: None
Marín-Sánchez et al. (Fri,) studied this question.