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



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.


Mechanical ventilation Tracheostomy Hospital survival Outcome research Scoring system 

Supplementary material

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


  1. 1.
    Christopher KL (2005) Tracheostomy decannulation. Respir Care 50:538–541PubMedGoogle Scholar
  2. 2.
    Ceriana P, Carlucci A, Navalesi P, Rampulla C, Delmastro M, Piaggi G, De Mattia E, Nava S (2003) Weaning from tracheostomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome. Intensive Care Med 29:845–848PubMedGoogle Scholar
  3. 3.
    Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM (1990) Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 108:655–659PubMedGoogle Scholar
  4. 4.
    Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB (2004) A prospective, randomized study comparing early dilational tracheostomy to prolonged translaryngeal intubation (delayed tracheostomy) in critically ill medical patients. Crit Care Med 32:1689–1694PubMedCrossRefGoogle Scholar
  5. 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. 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
  7. 7.
    Añón JM, Escuela MP, Gómez V, García de Lorenzo A, Montejo JC, López J (2004) Use of percutaneous tracheostomy in intensive care units in Spain. Results of a national survey. Intensive Care Med 30:1212–1215PubMedCrossRefGoogle Scholar
  8. 8.
    Engoren M, Arslanian-Engoren C, Fenn-Buderer N (2004) Hospital and long-term outcome after tracheostomy for respiratory failure. Chest 125:220–227PubMedCrossRefGoogle Scholar
  9. 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. 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
  11. 11.
    Combes A, Luyt CE, Nieszkowska A, Trouillet JL, Gibert C, Chastre J (2007) Is tracheostomy associated with better outcomes for patients requiring long-term mechanical ventilation? Crit Care Med 35:802–807PubMedCrossRefGoogle Scholar
  12. 12.
    Griffiths J, Barber VS, Morgan L, Young JD (2005) Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 330:1243–1248PubMedCrossRefGoogle Scholar
  13. 13.
    Kollef MH, Aherns TS, Shannon W (1999) Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit. Crit Care Med 27:1714–1720PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    Fernandez R, Baigorri F, Navarro G, Artigas A (2006) A modified McCabe Score for stratification of patients after ICU discharge: the Sabadell score. Crit Care 10:R179PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Nathens AB, Rivara FP, Mack CD, Rubenfeld GD, Wang J, Jurkovich GJ, Maier RV (2006) Variations in rates of tracheostomy in the critically ill trauma patient. Crit Care Med 34:2919–2924PubMedCrossRefGoogle Scholar
  18. 18.
    Freeman BD, Borecki IB, Coopersmith CM, Buchman TG (2005) Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med 33:2513–2520PubMedCrossRefGoogle Scholar
  19. 19.
    Maudsley G, Williams EM (1996) “Inaccuracy’ in death certification––where are we now? J Public Health Med 18:59–66PubMedGoogle Scholar

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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