K. C. Shue1,2, R. Stalder3,5, J. Wycech1,3, A. Tymchak1,2,3, J. Lozada3, A. A. Fokin1, I. Puente1,2,3,4 1Delray Medical Center,Trauma Services,Delray Beach, FL, USA 2Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA 5Wake Forest University,Winston-Salem, NC, USA
Introduction:
Timing of tracheostomy remains a subject of debate, whether early or late tracheostomy leads to better outcomes in trauma patients. The impact of tracheostomy timing on outcomes in trauma patients with rib fractures (RFX) has not been thoroughly investigated. The aim of this study was to examine the benefits of early tracheostomy (ET) in trauma patients with RFX.
Methods:
This IRB-approved retrospective cohort study, included 124 patients with radiologically-confirmed (X-rays and CT) rib fractures (RFX) admitted to two Level 1 Trauma Centers between January 2012 and December 2017, who have undergone a tracheostomy procedure. ET was defined as being performed within 7 days of mechanical ventilation initiation and late tracheostomy (LT) as being performed after one week. Patients were divided into 2 groups: ET (n = 40) or LT (n = 84). Analyzed variables included age, injury severity score (ISS), number of ribs fractured, number of the total fractures of ribs, presence of flail chest, bilateral rib fractures, pulmonary contusion, presence of traumatic brain injury (TBI), Glasgow Coma Scale (GCS), maxillofacial co-injuries, rate of ventilation-associated pneumonia (VAP), duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS) and hospital length of stay (HLOS).
Results:
Between the ET and LT groups, mean age (47.7 vs. 51.6 years), ISS (24.5 vs. 28.9), number of ribs fractured (4.8 vs. 5.4), number of total fractures of ribs (5.4 vs. 6.2), presence of flail chest (5.0% vs. 9.5%), bilateral rib fractures (35.0% vs. 26.8%), incidence of pulmonary contusion (60.0% vs. 56.0%), rate of TBI (42.5% vs. 47.6%), GCS (9.6 vs. 9.3) and maxillofacial co-injuries (52.5% vs. 34.5%) were not statistically different (all p>0.05).
As it comes to the outcome variables, ET group when compared to LT group had significantly shorter ICULOS (16.0 vs. 24.8 days; p<0.001), while rate of VAP (37.5% vs. 34.5%), DMV (24.8 vs. 28.6 days) and HLOS (38.1 vs. 41.4 days) were not statistically different in the ET and LT groups (all p>0.09).
Conclusion:
Early tracheostomy in trauma patients with rib fractures is associated with a shorter ICULOS when compared to late tracheostomy. Therefore, performing tracheostomy within 7 days of mechanical ventilation initiation should be considered in trauma patients with rib fractures.
