Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy

Abstract

Purpose The purpose of the study was to identify the predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy (PDT). Materials and Methods Retrospective analysis of data pertaining to adult patients who underwent PDT between July 2005 and June 2008 in an urban, academic, tertiary care medical center was done. Clinical and demographic data were analyzed for 483 patients undergoing PDT via multivariate logistic regression. Results Mortality data were examined at in-hospital, 14, 30, and 180 days postprocedure. Overall mortality rates were 11% at 14 days, 19% at 30 days, and 40% at 180 days. In-hospital mortality was 30%. Conclusions Patients undergoing PDT have significant short-term mortality with 11% dying within 14 days and an in-hospital mortality rate of 30%. We identified an index diagnosis of ventilator-associated pneumonia and trauma to be associated with a higher survival rate, whereas older age, oncological diagnosis, cardiogenic shock, and ventricular-assist devices were associated with higher mortality. There is significant heterogeneity in both underlying diagnosis and patient outcomes, and these factors should be considered when deciding to perform this procedure and discussed with patients/family members to provide a realistic expectation of potential prognosis.

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

“…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.…”

Subcutaneous Emphysema following Emergent Surgical Conventional Tracheostomy

“…Although percutaneous dilatational tracheostomy has become a routine procedure for airway management in critically ill patients, this operation is associated with serious complications no less than conventional tracheostomy. 18,19 We believe that both techniques require further improvement.…”

Fundamentals and Timing of Tracheostomy: ICU Team and Patient Perspectives

“…This is probably because these patients were too sick to even qualify for a tracheostomy. A chart review of 483 patients revealed that patients who received a tracheostomy had a mortality rate of 11% at 2 weeks, 19% at one-month, and 40% at 6 months after tracheostomy [33]. Moreover, in-hospital mortality was found to be 30% in all patients who received a tracheostomy.…”