Comparison of early and late tracheostomy in the outcome of multitrauma intubated patients: a double-blind clinical trial study

Abstract

Evidence on the benefits of early versus late tracheostomy is conflicting, and there is limited robust data to guide the ideal time to perform tracheostomy, which has led to the need for further research in this area. Since Imam Reza Hospital of Tabriz University of Medical Sciences is a center for trauma patients in the northwest of the country and the number of trauma patients in this hospital is very high and most of these patients are hospitalized and under mechanical ventilation for a long time, we decided to study To do this with the aim of comparing early and late tracheostomy on the final outcomes of these patients. Materials and Methods: This study was conducted as a randomized, double-blind, prospective, parallel-group clinical trial at Imam Reza Hospital, Tabriz University of Medical Sciences, with the participation of 90 patients hospitalized in the intensive care unit. Patients were divided into early and late tracheostomy groups and the final outcomes of patients were compared between the two groups. Age, gender, body mass index, mechanism of injury, initial GCS score during hospitalization in the intensive care unit, type of traumatic injury, performed or not. Surgery, history of previous diseases (high blood pressure, cardiovascular diseases, diabetes mellitus, history of stroke, lung diseases), duration of hospitalization, number of days connected to a ventilator, number of days in the intensive care unit Changes in GCS score during the first 30 days, surgical complications (infection, bleeding, emphysema, venous thromboembolism, acute respiratory distress syndrome, acute kidney injury), mortality, hospital discharge with and without the need for respiratory support were recorded for each patient. and finally a comparison was made between the two groups. Results: Comparing the incidence of ventilator-associated pneumonia during the first 30 days after tracheostomy indicated that the incidence of ventilator-associated pneumonia in the late tracheostomy group was non-significantly higher than the early tracheostomy group (P=0.115);The average length of hospitalization in the intensive care unit as well as the average length of hospitalization in the delayed tracheostomy group patients was significantly higher than the early tracheostomy group; The amount of GCS changes during the first thirty days after tracheostomy in early tracheostomy patients (average during 30 days=10.27±1.88) is significantly higher than the late tracheostomy group (average during 30 days=1.03±24 9.) was (P=0.231).