Impact of Early Tracheostomy on Clinical Outcomes in Trauma Patients Admitted to the Intensive Care Unit: A Retrospective Causal Analysis

Abstract

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.

Keywords: causal analysis; clinical outcome; intensive care unit; tracheostomy timing; trauma.