Benefits and challenges associated with the timing of tracheostomy in critically ill patients: experience at a tertiary intensive care unit


  • Priti S. Hajare Department of ENT and Head and Neck Surgery, KAHER’s J. N. Medical College, Belagavi, Karnataka, India
  • Rajesh Radhakrishna Havaldar Department of ENT and Head and Neck Surgery, KAHER’s J. N. Medical College, Belagavi, Karnataka, India



Tracheostomy, Ventilator associated pneumonia, Intensive care units


Background: Prolonged intubation in intensive care units (ICU) leads to damage to the airways. Tracheostomy is performed with an aim to facilitate pulmonary toileting and also protect the upper airways from the associated ill effects of prolonged endotracheal intubation. The timing of this procedure is a matter of considerable debate and varies according to different centres.

Methods: 50 patients were assessed. 34 belonged to the early group and 16 belonged to the late group. The study was carried out in the ICU of a tertiary care referral centre. The timing of occurrence of ventilator associated pneumonia (VAP), duration of ICU stay and duration of tracheostomy and the was compared between the early and late groups respectively.

Results: It was found that early tracheostomy leads to reduced ICU stay and delayed occurrence of VAP. The results were statistically significant. Additionally, it was also observed in this study that early tracheostomy leads to reduced duration of tracheostomy as compared to the late group although not statistically significant.

Conclusions: Due to large clinical heterogeneity amongst cases admitted to the ICU, the timing of tracheostomy is different in different centres. Hence, guidelines need to be formulated in order to perform tracheostomy in critically ill patients in order to prevent the demerits associated with late tracheostomy such as prolonged ICU stay, early occurrence of VAP and late decannulation. In addition to this, economic advantages also need to be considered as most of the population in developing countries do not have universal health insurance.

Author Biography

Rajesh Radhakrishna Havaldar, Department of ENT and Head and Neck Surgery, KAHER’s J. N. Medical College, Belagavi, Karnataka, India

Senior Resident, Department of ENT & Head and Neck Surgery, J.N.Medical College, KAHER, Belagavi


Trouillet JL, Collange O, Belafia F, Blot F, Capellier G, Cesareo E, et al. Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care. 2018;8(1):37.

Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989;96(1):178-80.

Heffner JE, Hess D. Tracheostomy management in the chronically ventilated patient. Clin Chest Med. 2001;22(1):55-69.

Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest. 1989;96(4):877-84.

Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984;94(3):367-77.

Liu CC, Livingstone D, Dixon E, Dort JC. Early versus late tracheostomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(2):219-27.

Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2015;1(1):7271.

Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32(8):1689-94.

Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483-9.

Zheng Y, Sui F, Chen XK, Zhang GC, Wang XW, Zhao S, et al. Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chin Med J. 2012;125(11):1925-30.

Brook AD, Sherman G, Malen J, Kollef MH. Early versus late tracheostomy in patients who require prolonged mechanical ventilation. Am J Crit Care. 2000;9(5):352-9.

Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005;9(1):46-52.

Georges H, Leroy O, Guery B, Alfandari S, Beaucaire G. Predisposing factors for nosocomial pneumonia in patients receiving mechanical ventilation and requiring tracheotomy. Chest. 2000;118(3):767-74.

Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990;108(4):655-9.

Shirawi N, Arabi Y. Bench-to-bedside review: early tracheostomy in critically ill trauma patients. Crit Care. 2006;10(1):201.

Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma. 2004;57(2):251-4.

Saffle JR, Morris SE, Edelman L. Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil. 2002;23(6):431-8.






Original Research Articles