Multidimensional Consequences of Delayed Surgical Tracheostomy in a Critically Ill Adult: A Case Report and Systems-Based Analysis

Background Delays in surgical tracheostomy can impact patients, families, and ICU systems. This case highlights the consequences of delays and gives suggestions on how to optimize care delivery. Patient case A 32-year-old female diagnosed with severe pneumococcal pneumonia presented with progressive shortness of breath, chest pain and cough. She continued to deteriorate despite non-invasive respiratory support, resulting in tracheal intubation and prolonged invasive ventilation. Intervention She required surgical tracheostomy to aid weaning because of anticipated difficulty with bedside percutaneous dilatational tracheostomy (PDT). Logistical and operating room scheduling problems led to a five-day delay. Outcome Delayed surgical tracheostomy resulted in significantly prolonged sedation burden, likely contributed to post-emergence delirium, delayed laryngeal and physical rehabilitation, distress for the relatives, and pressure on the healthcare system in terms of bed-days and economic costs. Conclusion Minimizing delays between decision for ICU tracheostomy and insertion improves outcomes for patients, their relatives, and hospital systems. Innovations enabling more ICU bedside PDT to be undertaken could reduce delays.