Tracheostomy care requires expertise for all caregivers and is challenging for people without specialized training. Specialized nursing and education protocols are associated with decreased complications of tracheostomy wounds. Children who are discharged directly to home are at higher risk for readmission compared with children discharged to advanced care facilities. Further development of caregiver education protocols is necessary to continue to reduce readmissions and tracheostomy-related complications.
Learning Objectives: Quality of life (QOL) deteriorates following intensive care and is known to be influenced by comorbidity. Sleep disturbance in survivors of critical illness is common but its association with QOL remains underexplored. This study aims to determine the long term QOL in critical illness survivors in the UK, assess association with comorbidities and identify predictive elements of reduced QOL and sleep disturbance. Methods: The EuroQol 5D (EQ-5D) and Insomnia Severity Index (ISI), questionnaires to assess health-related quality of life and insomnia, were sent to 289 patients admitted to the ICU at the Glasgow Royal Infirmary between July 2012 and December 2013. Clinical and demographic variables were recorded during ICU stay. Results: 101 individuals responded (35%), with a median follow up time from ICU discharge of 862 (557-1092) days. Median health utility score (HUS) was 0.656 (IQR 0.082 to 0.7960), with 16 survivors found to have a negative HUS, indicating a QOL worse than death. 14 patients had 3 or more comorbidities on ICU admission. There was a significant association between HUS and number of comorbidities (p=0.03) and HUS and insomnia (p=<0.001, R 2 =0.48). Lower QOL post ICU was associated with preexisting diagnoses of mental health problems (p=0.013), peripheral vascular disease (p=0.035) and cerebrovascular disease (p=0.03). Requirement for renal replacement therapy in ICU was associated with lower QOL post ICU (0.69 vs 0.05 p=0.01). There was no significant relationship found with vasopressor requirement or length of ventilatory support. There was no association between ICU or hospital length of stay and QOL. Conclusions: QOL following ICU stay is associated with many factors, including preexisting comorbidities and organ support during admission. Furthermore there is an association between insomnia following ICU and QOL. Further research will necessitate exploration of QOL pre and post ICU and interventions to improve QOL post ICU are required.
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