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, Results: In this cohort of 157 mechanically ventilated patients with severe intraventricular hemorrhage, baseline characteristics were well-balanced between Early (ET, Conclusion: In this single-center retrospective cohort study, early tracheostomy was associated with shorter durations of mechanical ventilation and ICU stay, as well as a lower incidence of major complications, and demonstrates a favorable safety profile. Although it does not improve long-term neurological function, early tracheostomy serves as an independent protective factor. When combined with the identification of risk factors such as GCS <6 and Graeb score ≥8, it provides a basis for individualized treatment. These findings suggest an association that warrants further investigation in prospective studies.