Impact of early vs. late tracheostomy on clinical outcomes in mechanically ventilated patients with intracerebral hemorrhage extending into the ventricles: a retrospective cohort study based on quantitative assessment of parenchymal and intraventricular hematoma volumes

Background The optimal timing for tracheostomy in patients with intracerebral hemorrhage extending into the ventricles who require mechanical ventilation remains controversial, and there is a paucity of evidence to guide clinical practice. This study aimed to elucidate the impact of early vs. late tracheostomy on clinical outcomes and complications in this population, utilizing multivariable models to identify risk factors and define the potential beneficiary population. Methods This single-center retrospective cohort study consecutively enrolled 157 patients with severe spontaneous intracerebral hemorrhage extending into the ventricles requiring mechanical ventilation (GCS score ≤8) between January 2020 and December 2023. Based on the timing of tracheostomy, patients were classified into an early group (ET, ≤7 days after mechanical ventilation, n = 81) and a late group (LT, >7 days after mechanical ventilation, n = 76). Baseline characteristics, treatment measures, and outcome data were collected. Hematoma volumes in both the brain parenchyma and ventricles on admission CT scans were precisely quantified using 3D Slicer software. The primary outcome was the 6-month modified Rankin Scale (mRS) score. Secondary outcomes included the duration of mechanical ventilation, ICU length of stay (LOS), and the incidence of short-term complications [ventilator-associated pneumonia (VAP), new-onset arrhythmia, shock, and acute kidney injury (AKI)]. Multivariable logistic regression analysis was employed to identify independent risk factors for complications and to assess the protective effect of early tracheostomy. Results In this cohort of 157 mechanically ventilated patients with severe intraventricular hemorrhage, baseline characteristics were well-balanced between Early (ET, n = 81) and Late Tracheostomy (LT, n = 76) groups. While 6-month functional outcomes (mRS) showed no significant difference ( P = 0.360), the ET group demonstrated substantially shorter duration of mechanical ventilation (13 vs. 19 days, P < 0.001) and ICU stay (17 vs. 25 days, P < 0.001). ET was associated with significantly lower incidence of ventilator-associated pneumonia (28.40 vs. 48.68%, P = 0.009), new-onset arrhythmia (18.52 vs. 32.89%, P = 0.039), and shock requiring vasopressors (24.7 vs. 40.79%, P = 0.031). Multivariable analysis identified GCS score