Compared with late tracheotomy, early intervention was associated with lower ventilator-associated pneumonia (VAP) rates and shorter durations of mechanical ventilation and ICU stay, but not with reduced short-term, all-cause mortality. These findings have substantial clinical implications and may result in practice changes regarding the timing of tracheotomy in severely ill adults requiring mechanical ventilation.

Surgically opening the windpipe, or trachea, within the first seven days of the start of mechanical ventilation decreases the time patients spend on ventilators, shortens their ICU stay and lowers their risk of ventilator-associated pneumonia.

The surgery, called tracheotomy, is performed either in the operating room or at the bedside, depending on patient risk factors.

The team analyzed 17 studies that included more than 3,000 patients.

The systematic review compared early versus late tracheotomy, with “early” defined as being performed seven days or shorter after initiation of ventilation and “late” defined as eight days or longer, including patients who never required a tracheotomy.

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