A comparison of early versus late tracheostomy after intubation for critically ill patients on long-term ventilation.

INTERVENTION: After intubation patients either entered the early (ET) or the late tracheostomy (LT) trunk of this study: In ET patients a percutaneous dilatational tracheostomy was performed within 4 days after intubation/trauma/surgery in LT patients the same procedure was performed after more than 6 days of intubation. The Acute Physiology And Chronic Health Evaluation II (APACHE II) score was used to define the severity of the trauma. In each group 25 patients with APACHE II < 25 and > 25 were recruited. Patients were followed until discharged from the hospital or rehabilitation centre. CONDITION: Intensive Care Units (ICUs); Percutaneous Dilatational Tracheostomy (PTD); ventilatory support ; Surgery PRIMARY OUTCOME: 1. VAP as defined by; 1.1. Clinical Pulmonary Infection Score (CPIS) ; 1.2. Sequential Organ Failure Assessment (SOFA) score; 2. APACHE II score; 3. Simplified acute physiology score (SAPS); 4. Temperature; 5. Laboratory values; 5.1. C‐Reactive Protein (CRP); 5.2. Leukocytes; 6. Thoracic X‐ray; 7. Days in ICU/hospital; 8. Hours of ventilatory support; ; APACHE II score was measured at baseline, all other outcomes were measured daily. INCLUSION CRITERIA: 1. Critically‐ill patients requiring ventilatory support and intubation, recruited from the following three ICUs: surgical, neurological, neurosurgical. 2. Expected time of ventilation > 21 days 3. Age > 18 years 4. Informed consent that the patient may be included into the study