The mortality rate and the optimal timing for performing a tracheostomy on intubated patients at Chaiyaphum Hospital.

Abstract

Tracheostomy in critically ill patients requiring prolonged mechanical ventilation is crucial for treatment outcomes. This research aimed to investigate the relationship between the duration of tracheostomy and mortality rate, and to analyze factors influencing mortality in patients who underwent tracheostomy. The study included 208 patients who underwent tracheostomy at the Chaiyaphum hospital in 2023. Data were collected from medical records and questionnaires, encompassing general information, primary diagnosis, comorbidities, the time interval from intubation to tracheostomy, and APACHE II scores. Data were analyzed using descriptive statistics and multivariate logistic regression analysis.

This study revealed that most patients were male (57.2%), with an average age of 61.93 years. Respiratory diseases were the primary reason for admission (36.5%), and the overall mortality rate was 46.2%. Our analysis showed that performing a tracheostomy within 15 days of intubation was linked to a lower mortality rate. We identified several factors significantly associated with increased mortality: ventilator-associated pneumonia (OR = 3.68; 95% CI 1.62, 8.33), heart disease (OR = 2.77; 95% CI 1.10, 7.00), and a higher APACHE II score (OR = 1.17; 95% CI 1.09, 1.25). Interestingly, neurological disease appeared to have a protective association, with an OR of 0.16 (95% CI 0.03, 0.78).

This study suggests that timely tracheostomy (within 15 days of intubation) may help reduce mortality in critically ill patients, particularly those with comorbid pneumonia or heart disease. Meanwhile, patients with neurological diseases may benefit the most from tracheostomy. Therefore, early tracheostomy should be considered in high-risk patients, and specific care guidelines for tracheostomized patients with comorbidities should be developed.