Ventilation & weaning · Timing of tracheostomy
Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Tracheotomy after 6 to 8 days of ventilation |
| Control | Tracheotomy after 13 to 15 days of ventilation |
| Population | 419 mechanically ventilated adult ICU patients |
| Follow-up | ICU stay |
| Primary endpoint | Incidence of ventilator-associated pneumonia |
| Result | Ventilator-associated pneumonia occurred in 30 patients (14%, 95% CI 10% to 19%) in the early group and 44 (21%, 95% CI 15% to 26%) in the late group (p=0.07). |
| Secondary endpoints | Ventilator-free days, ICU-free days, mortality |
Among mechanically ventilated adult ICU patients, early tracheotomy compared with late tracheotomy did not result in statistically significant improvement in incidence of ventilator-associated pneumonia.
The trial authors, in the published abstract
Reaches the same place as TracMan by a different endpoint. The p=0.07 is the kind of near-miss that invites over-reading; combined with TracMan's mortality result, the honest summary is that timing does not matter much and delay avoids unnecessary procedures.
Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 2010 Apr 21;303(15):1483-9.