Risk Stratification Using the Tracheostomy Early Prediction Score and the Association Between Early Tracheostomy and...

The impact of tracheostomy timing on mortality in mechanically ventilated patients is inconclusive, partly because identifying patients who require a tracheostomy is challenging. This study aimed to assess the association between tracheostomy timing and mortality using risk stratification based on the Sepsis Tracheostomy Early Prediction (STeP) score.

This retrospective cohort study used data from a Japanese Intensive Care Patient Database. Subjects with sepsis who required mechanical ventilation and underwent tracheostomy were included and classified into low- (0-2), moderate- (3-6), and high-risk (≥7) groups based on the STeP score. Early (≤7 d) and late (>7 d) tracheostomy were compared within each group using 1:1 propensity score matching (PSM). Sensitivity analyses were performed using a generalized linear mixed-effects model with hospitals as a random effect to account for between-hospital variability and the inverse probability of treatment weighting. The primary outcome was the in-hospital mortality rate.

After 1:1 PSM matching, 52, 114, and 404 matched pairs were obtained in the low-, moderate-, and high-risk groups, respectively. In the high-risk group, early tracheostomy was associated with a significantly lower mortality rate than late tracheostomy (28.0% vs 36.1%; odds ratio, 0.67, 95% CI 0.49-0.92). No significant differences were observed between low- and moderate-risk groups. These findings were consistent across sensitivity analyses.

Early tracheostomy was associated with lower mortality in high-risk subjects as identified by the STeP score, whereas no such association was observed in low- and moderate-risk patients.