A retrospective analysis of outcome after tracheostomy insertion in ITU at Mater Dei Hospital

Abstract

Introduction: Patients in critical care may require tracheostomy insertion, which provides a number of advantages, including decreased use of sedatives, easier weaning from mechanical ventilation and decreased incidence of ventilator-associated pneumonia. However, such patients require dedicated care until decannulation of the tracheostomy. The aim of this study is to analyse outcomes of patients who required a tracheostomy in ITU, and were subsequently discharged out of ITU. Methods: All patients admitted to ITU from January 2013 to December 2017 were studied: unfortunately, data from 2014 was incomplete. Demographic data obtained included age, gender, admission and discharge dates, insertion date of tracheostomy and length of duration with tracheostomy in ITU, and discharge location. The primary outcome was 30-day mortality. Other outcomes included 14-day and 1-year mortality, length of stay in ITU. Furthermore, a number of nurses in general and speciality wards were asked to fill in a questionnaire to assess their knowledge on tracheostomy care. Their results were compared to questionnaires given to ENT and ITU nurses. Results: In the period studied, 213 (9.4%) patients in ITU required a tracheostomy. 18% of these patients died in ITU. From the remaining 174 patients, 93 (53.4%) of such patients were discharged to a ward. 30-day mortality in these patients was 14.8%. When analysed by ward, 14-day and 30-day mortality in the general wards was higher compared to areas routinely having patients with tracheostomies (14d: 15.5% vs 6.0%, p = 0.054 / 30d: 19.7% vs 6.0%, p = 0.00999). Conclusion: Mortality is higher for patients with tracheostomy cared for in a general ward. Reasons for this are varied, and will be discussed. A prospective study set-up involving these kind of tracheostomy patients may provide further validated information.