Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient’s vulnerability
- 242 Downloads
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.
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.
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.
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.
KeywordsMechanical ventilation Tracheostomy Hospital survival Outcome research Scoring system
- 5.Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355PubMedCrossRefGoogle Scholar
- 6.Antonelli M, Michetti V, Di Palma A, Conti G, Pennisi MA, Arcangeli A, Montini L, Bocci MG, Bello G, Almadori G, Paludetti G, Proietti R (2005) Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med 33:1015–1020PubMedCrossRefGoogle Scholar
- 9.Frutos-Vivar F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, Soto L, Rodrigo C, Raad J, David CM, Matamis D, D’Empaire G, International Mechanical Ventilation Study Group (2005) Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med 33:290–298PubMedCrossRefGoogle Scholar
- 10.Clec’h C, Alberti C, Vincent F, Garrouste-Orgeas M, de Lassence A, Toledano D, Azoulay E, Adrie C, Jamali S, Zaccaria I, Cohen Y, Timsit JF (2007) Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis. Crit Care Med 35:132–138PubMedCrossRefGoogle Scholar
- 14.Hernandez G, Fernandez F, Lopez-Reina P, Arribas P, Zamora S, Del Olmo A (2007) Tracheostomy decannulation before ICU-discharge: an independent predictor of hospital survival. Intensive Care Med 33(Suppl 2):S141Google Scholar
- 16.Fernandez R, Tubau I, Hernandez G, Baigorri F, Artigas A (2007) Post-ICU tracheostomized patients in the ward: a non-uniform risk factor as assessed by the Sabadell score. Intensive Care Med 33(Suppl 2):S16Google Scholar