After stratifying by traumatic brain injury diagnosis, we compared ICU and hospital length of stay, pneumonia, and discharge disposition of patients with tracheostomy prior to three cut points (3, 7, and 14 d after admission) to 1) patients intubated at least as long as each cut point and 2) patients with tracheostomy on or after each cut point. Of 11,045 patients, 1,391 (12.6%) underwent tracheostomy. Median time to tracheostomy was 9 days (interquartile range, 6–13 d) for traumatic brain injury and 7 days (interquartile range, 3–12 d) for nontraumatic brain injury patients. Nontraumatic brain injury patients with tracheostomy prior to 7 days had 5.6 fewer ICU days and 5.7 fewer hospital days than patients intubated greater than or equal to 7 days and had 14.8 fewer ICU days and 15.3 fewer hospital days than patients with tracheostomy greater than or equal to 7 days. Similar differences were observed at 14 days but not at 3 days for both traumatic brain injury and non-traumatic brain injury patients. At the 3- and 7-day cut points, both traumatic brain injury and non-traumatic brain injury patients with tracheostomy prior to the cut point had a lower risk of pneumonia and risk of discharge to a facility than those with tracheostomy after the cut point.
Reference link- https://journals.lww.com/pccmjournal/fulltext/2021/07000/optimal_timing_of_tracheostomy_in_injured.5.aspx
