Ventilation & weaning · Timing of tracheostomy
Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation
| Design | Multicentre randomised trial |
|---|---|
| Treatment | Tracheostomy within 4 days of admission to critical care |
| Control | Tracheostomy after day 10 if still required |
| Population | 909 patients receiving mechanical ventilation |
| Follow-up | 2 years |
| Primary endpoint | All-cause mortality at 30 days |
| Result | Tracheostomy was performed in 91.9% of the early group but only 44.9% of the late group. Thirty-day mortality was 30.8% (95% CI 26.7% to 35.2%) early versus 31.5% (27.3% to 35.9%) late — absolute risk reduction 0.7 percentage points (95% CI -5.4 to 6.7). Two-year mortality was 51.0% versus 53.7% (p=0.74). Median critical care stay in survivors was 13.0 versus 13.1 days. Tracheostomy-related complications occurred in 6.3%. |
| Secondary endpoints | Two-year mortality, critical care length of stay, sedation use, complications |
For patients breathing with the aid of mechanical ventilation treated in adult critical care units in the United Kingdom, tracheostomy within 4 days of critical care admission was not associated with an improvement in 30-day mortality or other important secondary outcomes. The ability of clinicians to predict which patients required extended ventilatory support was limited.
The trial authors, in the published abstract
The most useful number is not the mortality result but that only 45% of the late group ever received a tracheostomy. Waiting spares roughly half of patients an invasive procedure at no cost in survival — which is the practical argument, and one Terragni 2010 reached independently.
Young D, Harrison DA, Cuthbertson BH, et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013 May 22;309(20):2121-9.