Tracheostomy Practices in the Intensive Care Unit post Non-traumatic Subarachnoid Hemorrhage: A Descriptive Retrospective Study

Abstract

Background:

Tracheostomy is frequently required in patients with non-traumatic subarachnoid hemorrhage (SAH) requiring prolonged mechanical ventilation. However, the optimal timing of tracheostomy remains uncertain, particularly regarding its impact on ventilator liberation and healthcare resource utilization.

Methods:

We conducted a retrospective cohort study of adult patients with non-traumatic SAH admitted between January 2015 and December 2024. Patients were categorized based on tracheostomy status and timing, with early tracheostomy defined as ≤10 days from intubation. Primary outcomes included duration of mechanical ventilation, ICU and hospital length of stay (LOS), complications, and mortality. Time-to-event analysis for ventilator liberation was performed using Kaplan–Meier curves and Cox proportional hazards modeling. Multivariable logistic regression was used to assess predictors of tracheostomy and mortality.

Results:

A total of 127 patients were included, of whom 33 (26.0%) underwent tracheostomy. Tracheostomized patients were older and more frequently male. Compared with non-tracheostomized patients, they had significantly longer ventilation duration (22.0 vs 5.0 days, p<0.0001), ICU LOS (27.0 vs 14.5 days, p<0.0001), and hospital LOS (53.0 vs 21.0 days, p<0.0001), and higher rates of ventilator-associated pneumonia (39.4% vs 5.3%, p<0.0001). Early tracheostomy was associated with shorter ventilation duration (20.0 vs 24.5 days, p=0.0138) and reduced hospital LOS (34.0 vs 57.0 days, p=0.0191). Kaplan–Meier analysis demonstrated earlier ventilator liberation with early tracheostomy (log-rank p=0.018). On Cox regression, early tracheostomy was independently associated with faster ventilator liberation (HR 3.66, 95% CI 1.55–8.68, p=0.003). Tracheostomy was not independently associated with mortality.

Conclusions:

In patients with non-traumatic SAH, tracheostomy is associated with increased resource utilization but not mortality. Early tracheostomy is associated with faster ventilator liberation and shorter hospital stay, supporting its role in optimizing respiratory recovery and ICU resource utilization.