Yoğun Bakımda Takip Edilen Akut İskemik İnme Hastalarında Trakeostomi Zamanlamasının Klinik Sonuçlara Etkisi: Retrospektif Kohort Çalışması

Öz

Bu çalışmada, yoğun bakım ünitesinde takip edilen akut iskemik inme hastalarında trakeostomi zamanlaması ile klinik sonuçlar arasındaki ilişkinin değerlendirilmesi amaçlandı. Bu retrospektif kohort çalışmada, 2020–2023 yılları arasında akut iskemik inme tanısıyla yoğun bakımda izlenen, invaziv mekanik ventilasyon gereksinimi olan ve trakeostomi uygulanan 136 hasta değerlendirildi. Hastalar entübasyondan trakeostomiye kadar geçen süreye göre çok erken (≤7 gün), erken (8–10 gün) ve geç (>10 gün) trakeostomi olmak üzere üç gruba ayrıldı. Primer sonlanım noktaları 28 ve 90 günlük mortaliteydi. Sekonder sonlanım noktaları yoğun bakım ve hastane yatış süresi, solunumsal parametreler ve post-trakeostomi pnömoni gelişimiydi. Gruplar arasında başlangıç demografik ve klinik özellikler açısından anlamlı fark yoktu. Çok erken trakeostomi, yoğun bakım ve hastane yatış süresinin anlamlı olarak daha kısa olmasıyla ilişkiliydi (her ikisi için p<0.001). Solunumsal parametreler ve post-trakeostomi pnömoni gelişimi açısından gruplar arasında anlamlı fark saptanmadı. 28 günlük mortalite benzerdi (p=0.866); buna karşın 90 günlük mortalite geç trakeostomi grubunda daha yüksekti (p=0.034). Çok değişkenli analizde geç trakeostomi (OR 3.82, %95 GA 1.48–9.92, p=0.006) ve kronik obstrüktif akciğer hastalığı (KOAH) (OR 8.69, %95 GA 2.72–27.78, p<0.001) 90 günlük mortalite ile bağımsız olarak ilişkili bulundu. Yoğun bakımda takip edilen akut iskemik inme hastalarında çok erken trakeostomi daha kısa yoğun bakım ve hastane yatış süresi ile, geç trakeostomi ise daha yüksek 90 günlük mortalite ile ilişkili bulundu. Ancak retrospektif tasarım, endikasyon biası olasılığı ve ayrıntılı nörolojik şiddet verilerinin bulunmaması nedeniyle bu bulgular dikkatli yorumlanmalı ve prospektif çalışmalarla doğrulanmalıdır.

Anahtar Kelimeler

• Yoğun bakım üniteleri
• Mekanik ventilasyon
• Mortalite
• İnme
• Trakeostomi

The Impact Of Tracheostomy Timing On Clinical Outcomes In Intensive Care Patients With Acute Ischemic Stroke: A Retrospective Cohort Study

Öz

This study aimed to evaluate the association between tracheostomy timing and clinical outcomes in patients with acute ischemic stroke managed in the intensive care unit (ICU).In this retrospective cohort study, 136 mechanically ventilated patients with acute ischemic stroke who underwent tracheostomy between 2020 and 2023 were analyzed. Patients were categorized into three groups according to tracheostomy timing after intubation: very early (≤7 days), early (8–10 days), and late (>10 days). The primary outcomes were 28-day and 90-day mortality. Secondary outcomes included ICU and hospital length of stay, respiratory parameters, and post-tracheostomy pneumonia. Baseline demographic and clinical characteristics were comparable among the groups. Very early tracheostomy was associated with significantly shorter ICU and hospital length of stay (p<0.001 for both). No significant differences were observed among the groups in respiratory parameters or post-tracheostomy pneumonia. While 28-day mortality was similar across groups (p=0.866), 90-day mortality was higher in the late tracheostomy group (p=0.034). In multivariable analysis, late tracheostomy (OR 3.82, 95% CI 1.48–9.92, p=0.006) and chronic obstructive pulmonary disease (COPD) (OR 8.69, 95% CI 2.72–27.78, p<0.001) were independently associated with 90-day mortality. In ICU patients with acute ischemic stroke, very early tracheostomy was associated with shorter ICU and hospital length of stay, whereas late tracheostomy was associated with higher 90-day mortality. These findings should be interpreted cautiously because of the retrospective design, potential confounding by indication, and absence of detailed neurological severity data. Prospective studies are needed to confirm these associations.

Anahtar Kelimeler

• Intensive care units
• Mechanical ventilation
• Mortality
• Stroke
• Tracheostomy

Kaynakça

1. 1. Feigin VL, Abate MD, Abate YH, Abd ElHafeez S, Abd-Allah F, Abdelalim A, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol. 2024;23(10):973–1003.
2. 2. Sič A, Tseriotis VS, Belanović B, Nemet M, Baralić M. Stroke management in the intensive care unit: ischemic and hemorrhagic stroke care. NeuroSci. 2025;6(4):121.
3. 3. Wallace S, McGrath BA. Laryngeal complications after tracheal intubation and tracheostomy. BJA Educ. 2021;21(7):250–7.
4. 4. Nyanzi DJ, Atwine D, Kamoga R, Birungi C, Nansubuga CA, Nyaiteera V, et al. Tracheostomy-related indications, early complications and their predictors among patients in low-resource settings: a prospective cohort study in the pre-COVID-19 era. BMC Surg. 2023;23(1):59.
5. 5. Merola R, Iacovazzo C, Troise S, Marra A, Formichella A, Servillo G, et al. Timing of tracheostomy in ICU patients: a systematic review and meta-analysis of randomized controlled trials. Life (Basel). 2024;14(9):1165.
6. 6. Bösel J, Niesen WD, Salih F, Morris NA, Ragland JT, Gough B, et al. Effect of early vs standard approach to tracheostomy on functional outcome at 6 months among patients with severe stroke receiving mechanical ventilation. JAMA. 2022;327(19):1899–909.
7. 7. Qiu Y, Yin Z, Wang Z, Xie M, Chen Z, Wu J, et al. Early versus late tracheostomy in stroke-related patients: a systematic review and meta-analysis. J Clin Neurosci. 2023;114:48–54.
8. 8. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis. 2016;63(5):e61–111.

9. 9. Premraj L, Camarda C, White N, Godoy DA, Cuthbertson BH, Rocco PRM, et al. Tracheostomy timing and outcome in critically ill patients with stroke: a meta-analysis and meta-regression. Crit Care. 2023;27(1):132.
10. 10. Siempos II, Ntaidou TK, Filippidis FT, Choi AMK. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015;3(2):150–8.
11. 11. Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2015;2015(1):CD007271.
12. 12. Zhang G, Liu H, Xia R, Zhang L, Liu K, Zhou D, et al. Characteristics associated with length of stay in intensive care unit for cancer patients in China: a nationwide retrospective cohort study. J Multidiscip Healthc. 2025;18:6025–35.
13. 13. Luo J, Zhang C, Deng R, Liu L, He C, Zhang R, et al. Risk factors for prolonged mechanical ventilation in critically ill patients with ischemic stroke. Neurotherapeutics. 2026;23(1):e00764.
14. 14. Chen Y, Lu L, Li X, Liu B, Zhang Y, Zheng Y, et al. Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database. BMC Pulm Med. 2023;23(1):435.