Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation

Abstract

Introduction: In critically ill patients undergoing prolonged mechanical ventilation (MV), the difference in long-term outcomes between patients with or without tracheostomy remains unexplored.

Methods: Ancillary study of a prospective international multicentre observational cohort in 21 centres in France and Belgium, including 2087 patients, with a one-year follow-up after admission. We included patients with a MV duration ≥10 days, with or without tracheostomy. We explored the one-year mortality with a classical Cox regression model (adjustment on age, SAPS II, baseline diagnosis and withdrawal of life-sustaining therapies) and a Cox regression model using tracheostomy as a time-dependant variable.

Results: 29.5% patients underwent prolonged MV, out of which 25.6% received tracheostomy and 74.4% did not. At one-year, 45.2% patients had died in the tracheostomy group and 51.5% patients had died in the group without tracheostomy (p = 0.001). In the Cox-adjusted regression model, tracheostomy was not associated with improved one-year outcome (HR CI95 0.7 [0.5-1.001], p = 0.051), as well as in the model using tracheostomy as a time-dependent variable (OR CI 95 1 [0.7-1.4], p = 0.9).

Conclusions: In our study, there was no statistically significant difference in the one-year mortality of patients undergoing prolonged MV when receiving tracheostomy or not.

Trial registration: NCT01367093.

Fig 1. Flowchart of the study.

Flowchart of patients with prolonged mechanical ventilation (≥ 10 days), with or without tracheostomy, included in the FROG-ICU sub-study.

Fig 2. One-year survival curves in patients with prolonged mechanical ventilation duration (≥10 days) with or without tracheostomy, in crude analysis and in propensity-analysis.

Kaplan-Meier curves of one-year mortality in crude analysis (p = 0.001, log-rank test, HR CI95 0.7 [0.5–1.001], p = 0.051, Panel A) and in a propensity-score analysis (HR CI95 0.6 [0.5–0.9], p = 0.02, Panel B).

Fig 3. Evolution of the MCS and PCS component of the SF-36 at 3, 6 and 12 months after ICU admission in patients with tracheostomy or no tracheostomy and prolonged mechanical ventilation.

The quality of life was measured by the Short Form-36 (SF-36) at 3, 6 and 12 months after ICU admission. SF-36 is a made of a mental (Mental Component Scale, MCS) and of a physical (Physical Component Scale, PCS) component. Each component ranges from 0 (poor quality of life) to 100 (upper quality of life). There is no significant difference in the MCS (Left panel, p = 0.5) and in the PCS (Right panel, p = 0.4) between the two groups. Two-way ANOVA.