Tracheostomy in patients with acute respiratory distress syndrome is not related to quality of life, symptoms of psychiatric disorders or return-to-work: the prospective DACAPO cohort study

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition that often requires prolonged mechanical ventilation. Tracheostomy is a common procedure with some risks, on the other hand with potential advantages over orotracheal intubation in critically ill patients. This study investigated the association of tracheostomy with health-related quality of life (HRQoL), symptoms of psychiatric disorders and return-to-work of ARDS survivors.Methods: Data were collected in the context of the prospective observational German-wide DACAPO study. Clinical and demographic patient data and treatment characteristics were obtained from the participating intensive care units (ICU). HRQoL and return-to-work were assessed using patient-reported questionnaires 3, 6 and 12 months after ICU discharge. HRQoL was measured with the Physical and Mental Component Scale of the Short-Form 12 Questionnaire (PCS-12, MCS-12). The prevalence of psychiatric symptoms (depression and post-traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire-9 and the Post-Traumatic Stress Syndrome-14. Physician-diagnosed anxiety and obsessive-compulsive disorder were recorded by patient self-report in the follow-up questionnaires. The associations of tracheostomy with HRQoL, psychiatric symptoms and return-to-work after 12 months were investigated by means of multivariable linear and logistic regression models.Results: Primary 877 ARDS patients (mean ± standard deviation: 54 ± 16 years, 68% male) survived and were discharged from ICU. Out of these patients, 478 (54.5%) were tracheotomised during ICU treatment. After 12 months, patient-reported outcomes could be analysed of 388 (44.2%) respondents, 205 with tracheostomy and 183 without. One year after ICU discharge, tracheostomy showed no significant association with physical or mental health-related quality of life (PCS-12: − 0.73 [− 3.96, 2.51]; MCS-12: − 0.71 [− 4.92, 3.49]), symptoms of psychiatric disorders (depression: 0.10 [− 1.43, 1.64]; PTSD: 3.31 [− 1.81, 8.43]; anxiety: 1.26 [0.41, 3.86]; obsessive-compulsive disorder: 0.59 [0.05, 6.68]) or return-to-work (0.71 [0.31, 1.64]) in the multivariable analysis (OR [95%-CI]).

Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis

“…However, the prospective study [ 73 ] included data spanning from the year 1997 to 2014, in which the role of lung-protective mechanical ventilation had yet to be established for most of the study duration (before 2010s) and thus may account for the reported higher mortality rate. On the other hand, a German-wide multi-center prospective cohort study (DACAPO study [ 74 ]) which evaluated the influence of quality of intensive care on patients with all-cause ARDS (non-COVID-19) reported a mortality rate of 27% in this cohort of patients, which was higher than the observed mortality estimate of COVID-19 associated ARDS in Germany (13%). Nevertheless, the German mortality estimate of ARDS in COVID-19 was originated from only one study [ 61 ], which included only 24 COVID-19 patients with ARDS, and therefore may be subject to high risk of selection biases.…”

“…However, the prospective study [73] included data spanning from the year 1997 to 2014, in which the role of lung-protective mechanical ventilation had yet to be established for most of the study duration (before 2010s) and thus may account for the reported higher mortality rate. On the other hand, a German-wide multi-center prospective cohort study (DACAPO study [74]) which evaluated the influence of quality of intensive care on patients with Figure 2. Pooled mortality estimate (%) in COVID-19 patients with ARDS (Heterogeneity: I 2 = 100%; p = 0.001).…”

Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a single-centre experience

“…Although our CAP-ARDS tracheostomy rates may be considered high by some standards, 5 they are similar to those in other primary ARDS cohorts from European nations, 22 and thus they do not reflect outlying clinical behaviour. Our recent article currently in press (https:// bjanaesthesia.…”

“…Although our CAP-ARDS tracheostomy rates may be considered high by some standards, 5 they are similar to those in other primary ARDS cohorts from European nations, 22 and thus they do not reflect outlying clinical behaviour. Our recent article currently in press ( https://bjanaesthesia.org/article/S0007-0912 (20)30678-4/fulltext) shows that we did not treat our SARS-CoV-2 patients any differently to our CAP-ARDS patients with regards to tracheostomy decisions, hence there being no significant difference between the groups.…”

Activities of daily living and psychiatric symptoms after intensive care unit discharge among critically ill patients with or without tracheostomy: a single center longitudinal study

“… 7 , 9 By contrast, comparatively few tracheostomized patients had long‐term mental health problems in other studies. 8 , 10 , 11 Post‐intensive care syndrome (PICS) comprises several domains, including physical, cognitive, and mental problems, which may lead to such disparity in results. Knowledge about elements of PICS is still limited, however, such as the difference between long‐term physical functional prognosis and mental health problems in tracheostomized patients.…”