Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2025 12 28 1368 1368 Behzad Ahsan Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. Qazal Ghaderi Student Research Committee, School of Nursing And Midwifery, Iran University of Medical Sciences, Tehran, Iran. Shariar Palizban Student Research Committee, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Khaled Rahmani Department of Family and Community Medicine, School of Medicine, Kurdistan University of Medical Science, Sanandaj, Iran. Mohamad Azad Majedi Department of Anesthesiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran. 2025 08 03 2025 10 01 Background: Tracheostomy is commonly performed in intensive care units to secure the airway of patients requiring prolonged mechanical ventilation. Although the procedure may improve patient comfort and facilitate airway management, it is also associated with potential complications such as bleeding and infection. Optimal timing of tracheostomy remains controversial and is influenced by clinical severity, physician decision-making, patient and family preferences, and institutional resources. Methods: This study included patients admitted to the intensive care unit of Kowsar Hospital, Sanandaj, Iran, between 2023 and 2024 who required prolonged mechanical ventilation. Participants were categorized into early (≤14 days) and late (>14 days) tracheostomy groups. Primary outcomes included one-month mortality and ventilator-associated pneumonia, while secondary outcomes comprised duration of mechanical ventilation, length of ICU and hospital stay, antibiotic exposure, chest radiographic findings, and arterial blood gas parameters, including pH and PCO₂. Results: Patients who underwent early tracheostomy experienced significantly shorter hospital stays (25.4 vs. 32.2 days) and required fewer days of antibiotic therapy (7.5 vs. 14.3 days) compared with those in the late tracheostomy group. The total duration of mechanical ventilation was also reduced in the early group. No statistically significant differences were observed between the two groups with respect to one-month mortality or complications such as ventilator-associated pneumonia and fever. Conclusion: Early tracheostomy was associated with improved clinical efficiency, reflected by reduced hospitalization duration, decreased antibiotic use, and shorter periods of mechanical ventilation, without an increase in mortality or procedure-related complications. These findings suggest that early tracheostomy represents a safe and cost-effective strategy for selected ICU patients requiring long-term ventilatory support. https://aacc.tums.ac.ir/index.php/aacc/article/view/1368