Abstract
Background
Study objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after intensive care unit (ICU) discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach.
Methods
This retrospective cohort study recruited all adult tracheostomy subjects admitted between January 2016 and December 2018. Long-term tracheostomy subjects with recurrent admissions and compromised airway, and subjects with neck tumors obstructing the airway were excluded. Data regarding subjects’ demographics, comorbidities, Glasgow Come Score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse, respiratory therapist, speech clinician, Ear, Nose, and Throat (ENT) specialist, and Rehab medicine specialist.
Results
Of the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none of them developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 days. Predictors of long-term tracheostomy were GCS <11 (odds ratio [OR], 5.6; 95% CI, 2.7–12), age ≥65 years (OR, 4.5; 95% CI, 2–10), comorbidities ≥2 (OR, 4.0; 95% CI, 1.5–11), and female sex (OR, 3.0; 95% CI, 1.3–7.4).
The proportion of subjects with long-term tracheostomy significantly increased with the total number of predictors (Fisher's exact test, P < 0.001).
Conclusion
Long-term tracheostomy is a common outcome among tracheostomy patients. Older age, low GCS, female gender, and the number of comorbidities were significant long-term tracheostomy predictors. Further studies to assess outcomes and predictors of tracheostomy subjects are needed.
Footnotes
- Corresponding Author:
Hashem Alhashemi, MBBS, MPH, FRCPC, Medicine Department, King Abdulaziz Medical City, P.O. Box 9515, Jeddah 21423, Saudi Arabia, Tel: +966122266666,Ext.22070, E-mail: Hashemhh{at}yahoo.com
- Received January 4, 2021.
- Accepted July 29, 2021.
- Copyright © 2021 by Daedalus Enterprises