Early Tracheostomy has fewer Endo laryngeal complications compared to late

New research found that endo laryngeal complications like laryngotracheal stenosis, stomal granulations, fistula, and nosocomial infections have a lower incidence in early tracheostomy when compared to late. The study was published in the journal "Indian Journal of Otolaryngology and Head & Neck Surgery." 

Tracheostomy is a common procedure in critically ill patients and a very common procedure performed in ICU for airway access and ventilation. It offers significant advantages over prolonged endotracheal intubation. Tracheostomy facilitates weaning by decreasing the work of breathing in patients with limited reserve. It has the advantage of decreasing the dead space area, decreasing the requirement for sedation, and may allow for earlier patient mobilization, feeding, and physical and occupational therapy as compared to prolonged intubation. The other benefits are lesser oral and oropharyngeal ulcerations, improved pulmonary toileting, and a lower incidence of pulmonary infections. Despite this, it is not devoid of risks. Hemorrhage, stoma infections and granulations, pneumothorax, subcutaneous emphysema, tracheal stenosis, tracheomalacia, and rare death are some of the complications. 

Researchers from Gujarat, India conducted a study to evaluate the early versus late tracheostomy for reduction of the length of ICU stay, the incidence of nosocomial pneumonia, risk of laryngeal injury, and mortality of mechanically ventilated patients. They conducted a retrospective study from May 2019 to April 2021 of patients being tracheostomized in the medical ICU at Civil Hospital, Ahmedabad. They included patients who were previously intubated endotracheally and were on mechanical ventilation. Physicians in the ICU would decide the necessity to tracheostomize.  

Results: 

• Endo laryngeal complications like laryngotracheal stenosis, stomal granulations, fistula as well as nosocomial infections had a lower incidence in early tracheostomy as compared to late. 
• Mortality, hospital, and ICU stay remained the same in both groups. 

Thus, the researchers concluded that there was a lower incidence of endolaryngeal complications and nosocomial infections in early tracheostomy as compared to late. They also added that mortality, hospital, and ICU stay were both in the same procedures. 

To read the full article, click here: https://doi.org/10.1007/s12070-022-03115-z 

Shah, G., Joshi, C., Prajapati, B.J. et al. Comparative evaluation of early versus late tracheostomy for reduction of the length of ICU stay, incidence of nosocomial pneumonias, risk of laryngeal injury and mortality of mechanically ventilated patients at a Tertiary Care Hospital in Western India. Indian J Otolaryngol Head Neck Surg (2022).