No Benefit from Early Trach for Prolonged Mechanical Ventilation

Early tracheostomy for prolonged mechanical ventilation might be a way to liberate patients earlier from ventilators and shorten intensive care unit length of stay. Meta-analyses of small studies have had mixed results, and practices vary dramatically. To assess the effect on mortality of early versus late tracheostomy, U.K. investigators randomized 909 patients in 72 critical care units to tracheostomy either within 4 days of admission to critical care (early trach) or after 9 days if it was still indicated (late trach). Patients were enrolled in the study if treating physicians deemed them likely to require at least 7 days of mechanical ventilation.

In the early-trach group, 85% of patients underwent tracheostomy within 4 days, and 8% unde…