Optimal timing for tracheostomy in severe ischemic stroke patients: early or standard incision?

Tracheostomy is frequently performed in severe ischemic stroke patients, yet the ideal timing for this procedure remains undefined. This study seeks to inform clinical decisions by evaluating the impact of early versus standard tracheostomy on clinical outcomes in this patient population.

We retrospectively reviewed severe ischemic stroke patients who underwent tracheostomy at our hospital between January 2013 and November 2023. Patients were categorized into early tracheostomy (ET) and standard tracheostomy (ST) groups based on the interval from intubation to tracheostomy. Clinical outcomes were compared between the two groups. The logistic regression model was used to assess the correlation between the timing of tracheostomy and outcomes, and the Kaplan-Meier method was employed to analyze time-to-event results.

The study encompassed 110 patients, with 57 in the ET group and 53 in the ST group. The results showed that the ET group had a longer interval from onset to intubation (P = 0.048), but there was no significant difference in the proportion of patients with severe disability after six months (OR 1.089 [95% CI 0.377-3.144], aOR 1.091 [95% CI 0.345-3.447]). The ET group demonstrated a shorter mechanical ventilation time (aOR 1.036 [95%CI 1.005-1.069]) and a decreased incidence of tracheostomy-related complications (aOR 5.378 [95%CI 1.065-27.144]).

Early tracheostomy does not affect the long-term outcomes of patients with severe ischemic stroke, but it may offer potential benefits.