This article is part of Pulmonology Advisor’s coverage of the CHEST Virtual 2020 meeting.
In mechanically ventilated patients with chronic obstructive pulmonary disease (COPD), early tracheostomy was associated with lower all-cause in-hospital mortality and length of hospital stay, according to research presented at the 2020 CHEST Annual Meeting, held virtually October 18 to 21.
Researchers conducted a retrospective analysis of an electronic health record database that included 72,585 patients with COPD who were hospitalized and mechanically ventilated between January 1, 2009, and June 29, 2018. The cohort was then restricted to patients receiving tracheostomy. Receiver operating characteristic (ROC) curve was used to define the most sensitive cut-off for tracheostomy timing to predict 90-day mortality, which was then implemented to create the early and late tracheostomy groups.
A total of 1728 patients were included in the final analysis. The most sensitive cut-off for timing was the ninth day of mechanical ventilation. By that definition, 617 patients received early tracheostomy, and 1111 received a late tracheostomy. In the early group, 90-day all-cause in-hospital mortality was significantly lower compared with the late group (15.24% vs 22.41%; odds ratio [OR], 0.632; 95% CI, 0.485-0.823; P =.0006). The length of stay was also significantly lower in the early group compared with the late group (median, 19 vs 29 days; OR, 0.709; 95% CI, 0.669-0.743; P <.001).
However, tracheostomy-related complications were significantly higher in the early group vs the late group (6.16% vs 4.5%; OR, 1.62; 95% CI, 1.041-2.523; P =.0326). Between the 2 groups, the risk of aspiration pneumonitis was not statistically different (OR, 0.771; 95% CI, 0.558-1.01; P =.059).
“This study will advance knowledge regarding this controversial topic and provide information about the usual care provided in US hospitals for this subgroup of patients,” the researchers concluded. They added that further studies are necessary to determine factors that may help clinicians predict which patients require prolonged ventilation.
Mohamed Y, Salzman G, Cheng A-L, Sahil S, Banderas J. Early vs delayed tracheostomy in mechanically ventilated patients with COPD. Presented at: the CHEST Virtual Annual Meeting; October 18-21, 2020. Abstract 1684.
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