The stroke care puzzle: Does tracheostomy timing fit?

Christopher Camarda, Lavienraj Premraj, Paolo Pelosi, Sung-Min Cho & Denise Battaglini. Crit Care DOI: 10.1186/s13054-023-04482-x

We thank Drs. Sutt and Fraser for their insightful commentary on our publication. They open an important debate on tracheostomy timing and outcomes of interest.

We concur that for decades, research has focused on “traditional” outcomes such as mortality and length of stay (LOS). Additionally, focus on tracheostomy-specific outcomes including swallowing, and communication may aid efforts to improve recovery after intensive care unit (ICU) discharge.

Our analysis of > 17,000 critically ill patients with severe stroke attempted to clarify whether tracheostomy timing is an important piece of the stroke management puzzle. Early tracheostomy (< 5 days from initiation of mechanical ventilation) was not associated with “traditional” outcomes or neurological outcome Modified Rankin Scale (mRS).