An audit of characteristics and outcomes in adult intensive care patients following tracheostomy

Abstract

Background:Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome.Materials and Methods:Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis of Diagnostic Related Group coding and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification procedural code. The primary endpoint was in-hospital mortality. Contingency tables were generated for clinical variables and a chi-squared test was used to determine significance.Results:One hundred and sixty-eight patients underwent tracheostomy between January 1999 and 30 June 2008. In-hospital mortality was 22.6%. The probability of death was found to be independent of timing of tracheostomy, technique used (percutaneous vs. surgical), number of failed extubations and obesity. On univariate analysis, the null hypothesis of independence was rejected for age on admission (P = 0.014), diagnosis of sepsis (P = 0.0008) or cardiac arrest (P = 0.0016), Acute Physiology and Chronic Health Evaluation II score (P = 0.0319) and the Australasian Outcomes Research Tool for Intensive Care calculated risk of death (P = 0.0432).Conclusion:Although a number of patient factors are associated with worse outcome, tracheostomy appears to be a relatively safe technique in the Intensive Care Unit population.

Characteristics, Resource Utilization, and Nursing Care of Patients Who Undergo Percutaneous Tracheostomy

“…The mean age in this study was 57.4 years as compared with 46.0 to 58.9 years in other studies. 16 Penuelas et al 17 identified a similar trend for a higher rate of reintubation and tracheostomy in those who demonstrated prolonged weaning. The percentage of subjects with a trauma diagnosis reported in these studies ranged from 13.7% to 70%.…”

“…3,14,16 Nearly half of the subjects in our study had a trauma diagnosis. The mean age in this study was 57.4 years as compared with 46.0 to 58.9 years in other studies.…”

“…3,14,16,24,25 The low mortality rate may be attributed to an intensivist model of care delivery for all critically ill patients at the study facility, especially because the SAPS and Acute Physiology, Age, Chronic Health Evaluation scores indicate a high severity of illness and associated increased mortality risk. 3,14,16,24,25 The low mortality rate may be attributed to an intensivist model of care delivery for all critically ill patients at the study facility, especially because the SAPS and Acute Physiology, Age, Chronic Health Evaluation scores indicate a high severity of illness and associated increased mortality risk.…”

Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit

“…[ 35 ] Ho et al ., in an audit of characteristics and outcomes in 168 adult ICU patients with tracheostomies concluded that tracheostomy appears to be a relatively safe technique in the ICU population and is not associated with adverse outcomes. [ 36 ] Frutos-Vivar et al . in a vast study in 361 ICUs across 12 countries observed that adjusting by other variables, tracheostomy was independently related with survival in the ICU (OR = 2.22; 95% CI, 1.72-2.86) but in-hospital mortality was similar with or without tracheostomy (39% vs. 40%, P =0.65).…”

Treatment Modalities and Thrombocytopenia Affect Mortality in Elderly Icu Patients- Observational Study in Tertiary Care Hospital in Northern India

“…Numerous studies in the literature support our findings. Ho et al, in an audit of characteristics and outcomes in 168 adult ICU patients with tracheostomies concluded that tracheostomy appears to be a relatively safe technique in the ICU population and is not associated with adverse outcomes [21].Frutos-Vivar et al in a vast study in 361 ICUs across 12 countries observed that adjusting by other variables, tracheostomy was independently related with survival in the ICU (OR = 2.22; 95% CI, 1.72-2.86) but in-hospital mortality was similar with or without tracheostomy (39% vs. 40%, P =0.65). [22] The SOFA score (11.77 ± 2.93) were significantly higher in non-survivors in the study (P < 0.05) as shown in [Table 4].…”