Early Versus Late Tracheostomy in Neurosurgical Intensive Care Patients Requiring Prolonged Mechanical Ventilation: A Prospective Observational Cohort Study
Aamir Hussain Hela, Zoya Sehar, Mohsin FayazAbstract
Background:
The optimal timing of tracheostomy in neurosurgical intensive care unit (ICU) patients remains uncertain. This study compared early- and late-tracheostomy groups in critically ill neurosurgical patients requiring prolonged mechanical ventilation.
Materials and Methods:
This prospective observational cohort study included 50 consecutive adult neurosurgical ICU patients who underwent surgical bedside tracheostomy between June and December 2024. Early tracheostomy was defined as tracheostomy performed within 7 days of intubation, and late tracheostomy was defined as tracheostomy performed after 7 days. The primary outcome was the duration of mechanical ventilation after tracheostomy. Secondary outcomes included sedation duration, ICU and hospital length of stay, ventilator-associated pneumonia (VAP), ICU mortality, and immediate procedure-related complications.
Results:
Of 50 patients, 29 underwent early tracheostomy and 21 underwent late tracheostomy. Early tracheostomy was associated with shorter post-tracheostomy mechanical ventilation duration compared with late tracheostomy (6.72 ± 5.46 vs. 10.29 ± 7.44 days;
Conclusion:
In this single-center prospective observational cohort, tracheostomy within 7 days of intubation was associated with shorter post-tracheostomy mechanical ventilation duration, reduced sedation exposure, and shorter ICU and hospital stay, without an observed increase in immediate complications. These findings require confirmation in larger multicenter studies with adjustment for neurological injury severity.