Impact of tracheostomy on clinical outcomes in ventilated patients with severe pneumonia: a propensity-matched cohort study

Abstract

Background/aims: Tracheostomy is a crucial intervention for severe pneumonia patients requiring prolonged mechanical ventilation (MV). However, debate persists regarding the influence of tracheostomy timing and performance on long-term survival outcomes. This study utilized propensity score matching to assess the impact of tracheostomy timing and performance on patient survival outcomes.

Methods: A retrospective observational study employing propensity score matching was conducted of respiratory intensive care unit (ICU) patients who underwent prolonged acute MV due to severe pneumonia from 2008 to 2023. The primary outcome was the 90-day cumulative mortality rate, with secondary outcomes including ICU medical resource utilization rates.

Results: Out of 1,078 patients, 545 underwent tracheostomy with a median timing of 7 days. The tracheostomy group exhibited lower 90-day cumulative mortality and a higher survival probability (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.43-0.63) than the no-tracheostomy group. The tracheostomy group had higher ICU medical resource utilization rates and medical expenditures. The early tracheostomy group (≤ 7 days) had lower ICU medical resource utilization rates and medical expenditures than the late tracheostomy group (> 7 days). However, there were no significant differences in the 90-day cumulative mortality rate and survival probability based on tracheostomy timing (HR 0.94, 95% CI 0.70-1.28).

Conclusion: Tracheostomy in patients with severe pneumonia requiring prolonged MV significantly reduced the 90-day mortality rate, and early tracheostomy may offer additional benefits for resource utilization efficiency. These findings underscore the importance of considering tracheostomy timing in optimizing patient outcomes and healthcare resource allocation.

Keywords: Mechanical ventilation; Mortality; Pneumonia; Propensity score; Tracheostomy.

Figure 1

Patient selection flow chart. MV, mechanical ventilation; ICU, intensive care unit. ^a)Included leukemia, cardiomyopathy, pulmonary edema, arrhythmia, diabetic ketoacidosis, and connective tissue disease.

Figure 2

Distribution of time to tracheostomy (from mechanical ventilator care to tracheostomy) (n = 545).

Figure 3

Kaplan–Meier survival curves of 90-day survival in (A) the matched tracheostomy and no-tracheostomy groups and (B) the matched early tracheostomy and late tracheostomy groups. HR, hazard ratio; CI, confidence interval.

Figure 4

Subgroup analysis of 90-day mortality in (A) the matched tracheostomy and no-tracheostomy groups and (B) the matched early tracheostomy and late tracheostomy groups. HR, hazard ratio; CI, confidence interval; BMI, body mass index; CCI, Charlson’s comorbidity index; APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Failure Assessment; NA, not available.