Earlier tracheostomy is associated with an earlier return to walking, talking, and eating. Issue 3 (May 2020)

• Record Type: Journal Article
• Authors: Sutt, Anna Liisa; Tronstad, Oystein; Barnett, Adrian G.; Kitchenman, Sarah; Fraser, John F.
• Is Part Of: Australian critical care. Volume 33:Issue 3(2020)
• Page Start: 213
• Page End: 218
• Publication Date: 2020-05
• Subjects: Communication -- Nutrition -- Patient outcomes -- Rehabilitation -- Tracheostomy timing; Intensive care nursing -- Periodicals; Intensive care nursing -- Australia -- Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.aucc.2020.02.006
• Languages: English
• ISSNs: 1036-7314

Abstract

Abstract: Background: Conjecture remains regarding the optimal timing for tracheostomy. Most studies examine patient mortality, ventilation duration, intensive care unit (ICU) length of stay, and medical complications. Few studies examine patient-centric outcomes. The aim of this study was to determine whether timing of tracheostomy had an impact on length of stay, morbidity, mortality, and patient-centric outcomes towards their functional recovery. Methods: This prospective observational study included data for all tracheostomised patients over 4 y in a tertiary ICU. The study time period commenced with the insertion of an endotracheal tube. Data collected included patient and disease specifics; mortality up to 4 y; mobility scores; and time to oral intake, talking, and out-of-bed exercises. To assess differences between timing of tracheostomy, a survival analysis was conducted to dynamically compare patients on days before and after tracheostomy tube (TT) placement during their ICU admission. Results: TT was placed in 276 patients. After tracheostomy, the patients were able to (on average) verbally communicate 7.4 d earlier (confidence interval [CI] = -9.1 to −4.9), return to oral intake 7.0 d earlier (CI = -10 to −4.6), and perform out-of-bed exercises 6.2 d earlier (CI = -8.4 to −4) than those who did not yet have a TT. In patients with an endotracheal tube, none were able to talk or have oral intake, and the majority (99%) did not participate in out-of-bed exercises/active rehabilitation. After tracheostomy, patients subsequently received significantly less analgesic and sedative drugs and more antipsychotics. No clear differences in ICU and long-term mortality were associated with tracheostomy timing. Conclusions: Earlier tracheostomy is associated with earlier achievement of patient-centric outcomes – patients returning to usual daily activities such as talking, out-of-bed mobility, and eating/drinking significantly earlier, whilst also receiving less sedatives and analgesics.