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Early Tracheotomy Doesn't Change Outcome for Patients on Ventilators

TUESDAY, April 20 -- Early tracheotomy does not significantly reduce the risk of pneumonia among patients on mechanical ventilation, a new study shows.

A tracheotomy is an incision made in the front of the neck through which a breathing tube is inserted directly into the windpipe (trachea). This is an alternative to placing a breathing tube through the mouth or nose.

In this study, Italian researchers investigated whether tracheotomy performed earlier (six to eight days) or later (13 to 15 days) after the start of mechanical ventilation in an intensive care unit (ICU) had an effect on the incidence of ventilator-associated pneumonia and its outcome.

They found that ventilator-associated pneumonia developed in 14 percent of early tracheotomy patients and in 21 percent of late tracheotomy patients.

"The numbers of ventilator-free and ICU-free days and the incidences of successful weaning [off the ventilator] and ICU discharge were significantly greater" in patients in the early tracheotomy group compared with patients in the late tracheotomy group, Dr. Pier Paolo Terragni, of the University of Turin, wrote in a news release. However, he noted, "there were no differences between the groups in survival at 28 days."

Compared with late tracheotomy, "early tracheotomy did not result in a significant reduction" in the incidence of ventilator-associated pneumonia in mechanically ventilated patients with a high risk of mortality, the researchers concluded in the same news release.

"These data suggest that a tracheotomy should not be performed earlier than after 13 to 15 days of [mechanical ventilation]," the researchers wrote.

The study appears in the April 21 issue of the Journal of the American Medical Association.

More information

The American College of Chest Physicians has more about mechanical ventilation.

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Posted: April 2010