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. 2023 Aug;38(8):727-736.
doi: 10.1177/08850666231160669. Epub 2023 Mar 7.

Patient-Centred Outcomes Following Tracheostomy in Critical Care

A Mc Mahon  1 , S Griffin  1 , Emma Gorman  1 , Aoife Lennon  1 , Stephen Kielthy  1 , Andrea Flannery  1 , Bindu Sam Cherian  1 , Minu Josy  1 , B Marsh  1
Affiliations

Patient-Centred Outcomes Following Tracheostomy in Critical Care

A Mc Mahon et al. J Intensive Care Med. 2023 Aug.

Abstract

Introduction: Around 20% of intensive care unit (ICU) patients undergo tracheostomy insertion and expect high-quality care concentrating on patient-centered outcomes including communication, oral intake, and mobilization. The majority of data has focused on timing, mortality, and resource utilization, with a paucity of information on quality of life following tracheostomy.

Methods: Single center retrospective study including all patients requiring tracheostomy from 2017 to 2019. Information collected on demographics, severity of illness, ICU and hospital length of stay (LOS), ICU and hospital mortality, discharge disposition, sedation, time to vocalization, swallow and mobilization. Outcomes were compared for early versus late tracheostomy (early = <day 10) and age category (≤ 65 vs ≥ 66 years).

Results: In total, 304 patients were included and 71% male, median age 59, APACHE II score 17. Median ICU and hospital LOS 16 and 56 days, respectively. ICU and hospital mortality 9.9% and 22.4%. Median time to tracheostomy 8 days, 8.55% open. Following tracheostomy, median days of sedation was 0, time to noninvasive ventilation (NIV) 1 day (94% of patients achieving this), ventilator-free breathing (VFB) 5 days (72%), speaking valve 7 days (60%), dynamic sitting 5 days (64%), and swallow assessment 16 days (73%). Early tracheostomy was associated with shorter ICU LOS (13 vs 26 days, P < .0001), reduced sedation (6 vs 12 days, P < .0001), faster transition to level 2 care (6 vs 10 days, P < .003), NIV (1 vs 2 days, P < .003), and VFB (4 vs 7 days, P < .005). Older patients received less sedation, had higher APACHE II scores and mortality (36.1%) and 18.5% were discharged home. Median time to VFB was 6 days (63.9%), speaking valve 7 days (64.7%), swallow assessment 20.5 days (66.7%), and dynamic sitting 5 days (62.2%).

Conclusion: Patient-centered outcomes are a worthy goal to consider when selecting patients for tracheostomy in addition to mortality or timing alone, including in older patients.

Keywords: communication; critical care; mobilization; oral intake; outcomes; patient centered; tracheostomy.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Timing of tracheostomy insertion following ICU admission in the total population. Abbreviation: ICU, intensive care unit.
Figure 2.
Figure 2.
Proportion of patients discontinuing sedation on each day following tracheostomy insertion.
Figure 3.
Figure 3.
Hospital discharge disposition for patients with tracheostomy stratified by age. Oldest ≥66, older 45 to 65, younger ≤44 years. Abbreviation: Other—other acute hospital, rehabilitation, nursing home, hospice, no fixed abode.
Figure 4.
Figure 4.
Age of patients at the time of tracheostomy insertion.
See this image and copyright information in PMC

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