Palestinian Medical and Pharmaceutical Journal (Pal. Med. Pharm. J.)

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Keywords

• ICU
• Ventilator-associated pneumonia
• Early tracheostomy
• APACHE II
• critical care
• mechanical ventilation

Abstract

Background: Tracheostomy is a common procedure in critically ill patients requiring mechanical ventilation; yet, the optimum timing for its use is still debated. Data from Palestinian intensive care units is lacking. Elective tracheostomy is a type of tracheostomy that is planned in advance of time instead of being done in an emergency. Early tracheostomy (ET), which was performed during the first 10 days of intubation, and late tracheostomy (LT), performed beyond the tenth day of intubation. The study examines vital inquiries concerning the impact of ET, in contrast to LT, on mortality, duration of ventilation, lengths of ICU and hospital stay, and the occurrence of VAP in critically ill patients. This study aimed to assess the clinical outcomes of ET, versus LT, among mechanically ventilated patients in the Palestinians intensive care units (ICUs). Method: A multicenter retrospective study was performed at Ibn Sina Specialized Hospital and Specialized Arab Hospital in northern West Bank, Palestine. All adult patients requiring mechanical ventilation who underwent elective tracheostomy from January 2023 to December 2024 were included (n = 66). Demographic data, clinical severity (GCS, APACHE II), timing of tracheostomy, procedure type, and results were gathered utilizing a standardized data collection form. Continuous variables are presented as medians and interquartile ranges (IQRs); categorical variables were evaluated using chi-square tests. The Mann-Whitney U test was employed for non-parametric comparisons of continuous outcomes. Results: Out of 66 patients, 37 received ET and 29 received LT. ET was associated with to markedly reduced post-tracheostomy mechanical ventilation duration (median: 12.0 vs. 21.0 days, p = .022), total ventilation duration (median: 20.0 vs. 34.0 days, p < .001), length of ICU stay (median: 25.0 vs. 40.0 days, p < .001), and length of hospital stay (median: 34.0 vs. 45.0 days, p < .001). In patients with an APACHE II score of ≤ 20, early treatment significantly decreased the incidence of VAP (20.8% compared to 53.8%, p = .041). Overall mortality was lower in ET patients (29.7% vs. 55.2%); however, subgroup analysis by APACHE II score showed no significant differences, suggesting that baseline severity affected mortality outcomes. Conclusion: ET correlates with enhanced ventilatory and recovery outcomes, as well as a decreased incidence of VAP in lower-risk patients; nevertheless, its impact on mortality remains indeterminate. These findings offer information to inform ICU procedures and resource allocation in Palestine, underscoring the necessity for prospective, large-scale investigations to elucidate survival advantages.

معلومات المقال

قيد النشر

الكلمات الإفتتاحية

• ICU
• Ventilator-associated pneumonia
• Early tracheostomy
• APACHE II
• critical care
• mechanical ventilation

الملخص

Background: Tracheostomy is a common procedure in critically ill patients requiring mechanical ventilation; yet, the optimum timing for its use is still debated. Data from Palestinian intensive care units is lacking. Elective tracheostomy is a type of tracheostomy that is planned in advance of time instead of being done in an emergency. Early tracheostomy (ET), which was performed during the first 10 days of intubation, and late tracheostomy (LT), performed beyond the tenth day of intubation. The study examines vital inquiries concerning the impact of ET, in contrast to LT, on mortality, duration of ventilation, lengths of ICU and hospital stay, and the occurrence of VAP in critically ill patients. This study aimed to assess the clinical outcomes of ET, versus LT, among mechanically ventilated patients in the Palestinians intensive care units (ICUs). Method: A multicenter retrospective study was performed at Ibn Sina Specialized Hospital and Specialized Arab Hospital in northern West Bank, Palestine. All adult patients requiring mechanical ventilation who underwent elective tracheostomy from January 2023 to December 2024 were included (n = 66). Demographic data, clinical severity (GCS, APACHE II), timing of tracheostomy, procedure type, and results were gathered utilizing a standardized data collection form. Continuous variables are presented as medians and interquartile ranges (IQRs); categorical variables were evaluated using chi-square tests. The Mann-Whitney U test was employed for non-parametric comparisons of continuous outcomes. Results: Out of 66 patients, 37 received ET and 29 received LT. ET was associated with to markedly reduced post-tracheostomy mechanical ventilation duration (median: 12.0 vs. 21.0 days, p = .022), total ventilation duration (median: 20.0 vs. 34.0 days, p < .001), length of ICU stay (median: 25.0 vs. 40.0 days, p < .001), and length of hospital stay (median: 34.0 vs. 45.0 days, p < .001). In patients with an APACHE II score of ≤ 20, early treatment significantly decreased the incidence of VAP (20.8% compared to 53.8%, p = .041). Overall mortality was lower in ET patients (29.7% vs. 55.2%); however, subgroup analysis by APACHE II score showed no significant differences, suggesting that baseline severity affected mortality outcomes. Conclusion: ET correlates with enhanced ventilatory and recovery outcomes, as well as a decreased incidence of VAP in lower-risk patients; nevertheless, its impact on mortality remains indeterminate. These findings offer information to inform ICU procedures and resource allocation in Palestine, underscoring the necessity for prospective, large-scale investigations to elucidate survival advantages.