Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients. (7th July 2015)

• Record Type: Journal Article
• Authors: Patel, Sapna A.; Plowman, Emily K.; Halum, Stacey; Merati, Albert L.; Sardesai, Maya G.
• Is Part Of: Laryngoscope. Volume 125:Number 9(2015:Sep.)
• Page Start: 2134
• Page End: 2138
• Publication Date: 2015-07-07
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25322
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25322-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>To determine whether the timing of tracheotomy placement impacts ventilation weaning status and mortality.</p> </sec> <sec id="lary25322-sec-0002" sec-type="section"> <title>Study Design</title> <p>Multi‐institution retrospective cohort study.</p> </sec> <sec id="lary25322-sec-0003" sec-type="section"> <title>Methods</title> <p>Demographic data, procedural details, and clinical outcomes were recorded for patients undergoing tracheotomy for prolonged mechanical ventilation across eight sites. The study group was divided into two groups: those undergoing tracheotomy within 14 days of initiation of mechanical ventilation and those undergoing tracheotomy at or after 14 days. Groups were compared for primary outcome measures of mortality and ability to wean from mechanical ventilation within the study period.</p> </sec> <sec id="lary25322-sec-0004" sec-type="section"> <title>Results</title> <p>Of the 539 patients intubated for ventilator dependence with complete data available, 280 (51.9%) underwent tracheotomy within 14 days. Patients who underwent late tracheotomy were 1.72 times more likely to remain ventilator dependent during the follow‐up period (95% confidence interval [CI]: 1.12‐2.66), and had a 40% increased risk of death (odds ratio: 1.4, 95% CI: 0.96‐1.99).</p> </sec> <sec id="lary25322-sec-0005" sec-type="section"> <title>Conclusions</title> <p>In this multicenter retrospective review of tracheotomy outcomes, late tracheotomy placement (>14 days) was associated with increased mortality and prolonged ventilator dependence. Standardized multidisciplinary management protocols for prolonged mechanical ventilation are recommended, and future work should confirm these results in a prospective manner.</p> </sec> <sec id="lary25322-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4 <italic>Laryngoscope</italic>, 125:2134–2138, 2015</p> </sec> </abstract>