Early vs Late Hybrid Percutaneous Tracheostomy in Intensive Care: A Bolivian Retrospective Cohort Study
Keywords:
Latin America, Survival analysis, Quality of life, Tracheostomy, Intensive care units, Mechanical ventilationAbstract
Introduction: Hybrid tracheostomy combines surgical and percutaneous techniques and is most commonly used in intensive care units with limited resources. However, uncertainty remains regarding the optimal timing of its placement. Objective: To evaluate whether early (≤ 7 days) versus late (> 7 days) hybrid tracheostomy is associated with in-hospital mortality, live discharge, and days alive out of the hospital (DAOH) in critically ill patients on mechanical ventilation. Materials and methods: Retrospective cohort study of consecutive adult patients on mechanical ventilation admitted to the intensive care unit of a tertiary hospital in Cochabamba, Bolivia. A total of 161 patients who underwent hybrid tracheostomy (single dilation, Blue Rhino type, Portex cannula, and Griggs clamp support) were included. The procedure was performed early or late, according to the treating team's judgment. The primary outcomes were in-hospital mortality, live discharge, 28- and 60-day long-term use of a tracheostomy tube (LTT), and tracheostomy-related complications. Results: Early tracheostomy was associated with a higher cumulative incidence of live discharge (subhazard ratio [sHR] 1.25; 95% CI 1.01–1.55) and an increased risk of in-hospital death (sHR 1.35; 95% CI 1.02–1.80). The complication rate was low. Long-term use of a LTT at 28 and 60 days was higher in the early group (LTT-60: 15.8 vs. 8.1 days). Discussion: Early hybrid tracheostomy is associated with faster resolution of the hospital stay and longer use of a LTT. Conclusion: The increased mortality may reflect indication bias in more severely ill patients. Decisions regarding the optimal timing should be individualized.
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