Intensive Care Units/statistics and numerical data Respiration, Artificial/mortality Tracheostomy
Lippincott, Williams & Wilkins
Fernandez R, Tizon AI, Gonzalez J, Monedero P, Garcia-Sanchez M, et al. Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis. Crit Care Med. 2011 Oct;39(10):2240-2245.
To analyze the impact of decannulation before intensive care unit
discharge on ward survival in nonexperimental conditions. DESIGN: Prospective,
observational survey. SETTING: Thirty-one intensive care units throughout Spain.
PATIENTS: All patients admitted from March 1, 2008 to May 31, 2008.
INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At intensive care unit
discharge, we recorded demographic variables, severity score, and intensive care
unit treatments, with special attention to tracheostomy. After intensive care
unit discharge, we recorded intensive care unit readmission and hospital
survival. STATISTICS: Multivariate analyses for ward mortality, with Cox
proportional hazard ratio adjusted for propensity score for intensive care unit
decannulation. We included 4,132 patients, 1,996 of whom needed mechanical
ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the
intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60
were decannulated in the intensive care unit and 141 were discharged to the ward
with cannulae in place. Variables associated with intensive care unit
decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs.
76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and
good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a
propensity score model for decannulation. Crude ward mortality was similar in
decannulated and nondecannulated patients (22% vs. 23%); however, after
adjustment for the propensity score and Sabadell Score, the presence of a
tracheostomy cannula was not associated with any survival disadvantage with an
odds ratio of 0.6 [0.3-1.2] (p=.1). CONCLUSION: In our multicenter setting,
intensive care unit discharge before decannulation is not a risk factor.