2013 Sept 25 - Timing of Tracheostomy
Kenneth W. Altman, MD; Albert L. Merati, MD
To the Editor Dr Young and colleagues conducted a multicenter, prospective study on tracheostomy timing involving 72 critical care units in the United Kingdom over an 8-year period. The authors randomized patients into early vs late tracheostomy groups and found comparable mortality, critical care unit length of stay, and tracheostomy complications. Although we agree with the major conclusion that study clinicians could not reliably predict who would need a tracheostomy, we suggest caution regarding other conclusions and those of the accompanying Editorial based on study limitations and a narrow set of outcome measures...
Chien-Ming Chao, MD; Chih-Cheng Lai, MD
To the Editor The TracMan (Tracheostomy Management) study investigated the effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation. In this study, no significant benefit was found for early tracheostomy. Although there were no significant differences for mortality or critical care unit length of stay between the early and late tracheostomy groups, other clinical outcomes of early tracheostomy should be taken into consideration...
Duncan Young, DM
In Reply Drs Altman and Merati mention that our low per-site recruitment rate might mean our results could not be generalizable to other populations of critical care patients. The study flow diagram would suggest otherwise. Of 3147 patients screened, 2236 were excluded but only 740 of these were for reasons that might not be relevant outside a trial (for example, refusal of consent for the study). The rest of the patients were excluded for clinical reasons. This suggests there is probably only a small population in whom early tracheostomy is feasible...
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