# Weaning outcomes after early vs. late tracheostomy in severe burn injury: a retrospective single-center study

## TL;DR

This study compares the outcomes of early and late tracheostomy in severe burn patients, finding no significant benefit of early tracheostomy in weaning from ventilation.

## Contribution

The study provides new clinical insights into the effectiveness of early versus late tracheostomy in severe burn patients.

## Key findings

- Early tracheostomy led to significantly earlier progression to CPAP-mode compared to late tracheostomy.
- No significant differences were observed in time to decannulation or overall weaning success between the two groups.
- In-hospital mortality rates were similar between early and late tracheostomy groups.

## Abstract

Patients with severe burn injuries often require prolonged mechanical ventilation (MV). The benefit of an early tracheostomy (ET; ≤ 10 days after injury) to reduce MV duration and facilitate weaning remains unclear. This study aimed to compare weaning outcomes between patients undergoing ET and late tracheostomy (LT; > 10 days after injury) in a high-volume burn center.

We conducted a retrospective analysis of 67 patients admitted to our burn intensive care unit from January 2015 to June 2024. The patients were assigned to two groups based on the timing of the tracheostomy: ET (n = 52) and LT (n = 15). Endpoints of the study were the influence of tracheostomy timing on the time to milestones in the weaning process (CPAP, intermittent breathing without MV, decannulation) and ICU length of stay.

The mean age was 52.9 (± 19.7) years. The ABSI-scores were similarly distributed, with medians of 9 in the ET group and 8 in the LT group. Inhalation trauma was present in 55.2% of patients across both groups (ET n = 29 (55.8%); LT n = 8 (53.3%)). Regarding weaning milestones, no significant differences were observed in the median time to first intermittent breathing without MV (ET 15 days vs. LT 20 days; p = 0.47) or median time to decannulation (ET 33 days vs. LT 69 days; p = 0.28). However, patients in the ET group reached CPAP significantly earlier than those in the LT group (ET 7 days vs. LT 13 days; p < 0.001). Overall, in-hospital mortality rate was 43.3% (ET 46.2% vs. LT 33.3%; p = 0.38).

This study found no substantial benefit associated with early-onset tracheostomy in patients with severe burn injuries. While ET resulted in significantly earlier progression to CPAP-mode, it did not expedite overall weaning success or reduce time to decannulation. While the sample size may limit sensitivity to detect smaller effects, the findings provide insight into weaning dynamics following early versus LT in burn patients. These findings underscore the need for standardized, prospective evaluation in this population.