Medical and Health Sciences

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https://hdl.handle.net/20.500.11888/18295

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Browsing Medical and Health Sciences by Author "Abu Tammam, Abdelrauof"

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    EARLY VERSUS LATE TRACHEOSTOMY IN THE MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS: A RETROSPECTIVE MULTICENTER COHORT STUDY IN PALESTINE
    (An-Najah National University, 2025-09-02) Abu Tammam, Abdelrauof
    Background: Prolonged mechanical ventilation (PMV) is a particularly common reason for tracheostomy in patients hospitalized to intensive care units (ICU). The operation is classified as "early" or "late" based on the date of its execution relative to the start of mechanical ventilation (MV). Although the evidence for early versus late tracheostomy varies, early tracheostomy has been linked to shorter hospital stays and lower mortality rates. No previous studies in Palestine have compared or assessed the optimal timing of tracheostomy, although some hospitals follow an ET protocol for expected PMV patients. Aim: To compare the clinical outcomes of early vs late tracheostomy for mechanically ventilated critically ill patients in the ICU. Methods: This retrospective multicenter observational cohort research was carried out in Palestine from January 2023 to December 2024. Patients who had elective tracheostomies were divided into two groups: early tracheostomy (ET), which was performed during the first 10 days of intubation, and late tracheostomy (LT), which was performed beyond the tenth day. The major outcomes assessed were mortality, duration of MV, length of stay in the ICU and hospital, and incidence of ventilator-associated pneumonia (VAP). These outcomes were evaluated and compared among groups, both overall and stratified by APACHE II scores. Results: About 66 patients were included in the study, 37 in the ET and 29 in the LT. ET was associated with significantly lower mortality (P = 0.033), shorter duration of MV (P <0.001), and reduced length of ICU (P < 0.001) and total hospital stays (P <0.001). VAP rates were not significantly different (P = 0.083). In patients with APACHE II ≤ 20, ET significantly improved all outcomes except mortality (P = 0.405). In patients with APACHE II > 20, ET significantly reduced the total duration of MV (P = 0.009), length of ICU and hospital stays (P = 0.037; P = 0.035, respectively) while having no significant impact on mortality (P = 0.238), duration of post-tracheostomy MV (P = 0.236), and VAP (P = 0.474). Conclusion: ET appears to be associated with improved outcomes compared with LT, particularly in lower-risk patients.