Preadmission tracheostomy is associated with better outcomes in patients with prolonged mechanical ventilation in the postintensive care respiratory care setting

Chun-Ta Huang; Jou-Wei Lin; Sheng-Yuan Ruan; Chung-Yu Chen; Chong-Jen Yu

doi:10.1016/j.jfma.2016.05.005

Preadmission tracheostomy is associated with better outcomes in patients with prolonged mechanical ventilation in the postintensive care respiratory care setting

J Formos Med Assoc. 2017 Mar;116(3):169-176. doi: 10.1016/j.jfma.2016.05.005. Epub 2016 Jul 9.

Authors

Chun-Ta Huang¹, Jou-Wei Lin², Sheng-Yuan Ruan³, Chung-Yu Chen², Chong-Jen Yu⁴

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jefferycjyu@ntu.edu.tw.

PMID: 27401698
DOI: 10.1016/j.jfma.2016.05.005

Abstract

Background/purpose: Prolonged mechanical ventilation (PMV) is the most common situation where tracheostomy is indicated for intensive care unit (ICU) patients. However, it is unknown if this procedure confers survival benefits on PMV patients in a post-ICU setting.

Methods: Patients who were admitted to the specialized weaning unit from 2005 to 2008 and received PMV were included in this study. On admission, data pertaining to patient characteristics, physiologic status, and type of artificial airway (tracheostomy vs. no tracheostomy) were obtained. Outcomes of tracheostomized and nontracheostomized patients were evaluated using multivariate Cox proportional hazards and propensity score-matching models. The primary outcome of interest was 1-year survival.

Results: A total of 401 patients (mean age 74.4 years, 204 male) were identified. In multivariate analyses, higher Acute Physiology and Chronic Health Evaluation II score [hazard ratio (HR) = 1.061, 95% confidence interval (CI) = 1.016-1.107] and presence of comorbidities, including congestive heart failure (HR = 1.562, 95% CI = 1.119-2.181), malignancy (HR = 1.942, 95% CI = 1.306-2.885), and liver cirrhosis (HR = 2.373, 95% CI = 1.015-5.544), were independently associated with 1-year mortality. An association between having tracheostomy and a better 1-year outcome was observed (HR = 0.625, 95% CI = 0.453-0.863). The matched cohort study also demonstrated a favorable 1-year survival for tracheostomized patients, and these patients had significantly lower in-hospital mortality (24% vs. 36%, p = 0.049) and risk of ventilator-associated pneumonia (10% vs. 20%, p = 0.030) than nontracheostomized ones.

Conclusion: Preadmission tracheostomy may be associated with better outcomes of PMV patients in a post-ICU respiratory care setting. The findings suggest that this procedure should be recommended before PMV patients are transferred to specialized weaning units.

Keywords: outcome; prolonged mechanical ventilation; specialized weaning unit; tracheostomy; weaning.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Female
Hospital Mortality*
Humans
Intensive Care Units
Length of Stay
Logistic Models
Male
Middle Aged
Multivariate Analysis
Pneumonia, Ventilator-Associated / epidemiology*
Survival Analysis
Taiwan
Time Factors
Tracheostomy*
Ventilator Weaning*