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Intensive Care Medicine

, Volume 34, Issue 10, pp 1878–1882 | Cite as

Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient’s vulnerability

  • Rafael FernandezEmail author
  • Nestor Bacelar
  • Gonzalo Hernandez
  • Isabel Tubau
  • Francisco Baigorri
  • Gisela Gili
  • Antonio Artigas
Brief Report

Abstract

Objective

To determine the effect of discharge from the ICU with a tracheostomy tube on ward mortality and its relation to patient vulnerability.

Design and setting

Retrospective single-center cohort study.

Methods

Database (2003–2006) review of patients undergoing mechanical ventilation (MV) > 24 h and discharged from the ICU with or without tracheostomy tube in place and followed up to hospital discharge or death. We recorded clinical characteristics, complications, major ICU procedures, subjective prognosis at ICU discharge (Sabadell score), and hospital outcome. Factors associated with ward mortality were analyzed by multiple logistic regression.

Results

From 3,065 patients admitted to the ICU, 1,502 needed MV > 24 h. Only 936 patients (62%) survived the ICU and were transferred to the ward; of these, 130 (13.9%) had a tracheostomy tube in place. Ward mortality was higher in patients with a tracheostomy tube in place than in those without (26 vs. 7%, P < 0.001). Increased ward mortality among cannulated patients was seen only in those with intermediate Sabadell score (24 vs. 9% in score 1, P = 0.02, and 38 vs. 24% in score 2, P = 0.06), but not in the “good prognosis” (2 vs. 2%, score 0) and “expected to die in hospital” (80 vs. 75%, score 3) groups. Multivariate analysis found three factors associated with ward mortality: age, tracheostomy tube in place, and Sabadell score.

Conclusion

Lack of tracheostomy decannulation in the ICU appears to be associated with ward mortality, but only in the group with a Sabadell score of 1.

Keywords

Mechanical ventilation Tracheostomy Hospital survival Outcome research Scoring system 

Supplementary material

134_2008_1169_MOESM1_ESM.doc (32 kb)
MOESM1 (DOC 32 kb).

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Rafael Fernandez
    • 1
    Email author
  • Nestor Bacelar
    • 1
  • Gonzalo Hernandez
    • 2
  • Isabel Tubau
    • 1
  • Francisco Baigorri
    • 1
  • Gisela Gili
    • 1
  • Antonio Artigas
    • 1
  1. 1.Critical Care CenterHospital de Sabadell, CIBERESSabadellSpain
  2. 2.Critical Care CenterHospital de ToledoToledoSpain

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