(1742) Timing of Tracheostomy in Neurotrauma Patients: A Single Level 1 Trauma Center Experience

Introduction: Tracheostomy is typically performed on critically ill patients who require prolonged mechanical ventilation and is necessary to continue care outside of the Intensive Care Unit (ICU). It has been associated with decreased duration of ICU and hospital stays as well as duration of mechanical ventilation and reduced complications such as ventilator-associated pneumonia (VAP). However, data is conflicting regarding tracheostomy timing and its potential benefits when performed early, especially in patients with neurotrauma. The aim of this study is to investigate tracheostomy timing in relation to patient-specific factors in neurotrauma patients hospitalized in a tertiary trauma level I hospital.

Methods: An initial retrospective analysis of a hospital trauma registry database was performed on adult neurotrauma patients requiring mechanical ventilation with consequent tracheostomy between the years 2016-2024. 220 patients were divided according to tracheostomy timing (early < 7 days vs. late) and further analyzed based on patient-specific factors and outcomes. Statistical analysis was performed using Mann-Whitney U, chi-square, and Fisher’s exact tests with significance defined as p< 0.05.

Results: 76% of patients had late tracheostomies. Between the late and early groups there was no significant difference in age (p=0.29), BMI (p=0.89), sex (p=0.65) and Injury Severity Score (ISS) (p=0.24). There was no significant difference in location of tracheostomy procedure (neurosurgical ICU - NICU vs. surgical ICU - SICU) (p=0.4). The late group was associated with longer mechanical ventilation time (p=0.00019) as well as longer ICU stay (p=0.0000008). 87% of the early and 96% of the late group survived the ICU, with the late group having significantly higher survival outcomes (p=0.018).

Conclusions: Our findings suggest that independent of injury severity, early tracheostomy is associated with shorter ICU stay and duration of mechanical ventilation but may be associated with a higher ICU mortality.