[Tracheostomy in intensive care: impact on prognosis and the influence of underlying chronic respiratory insufficiency].
BACKGROUND
Numerous uncertainties remain concerning the place of tracheostomy in intensive care. Reluctance to perform tracheostomy is common, particularly in the presence of pre-existing chronic respiratory insufficiency (CRI), but some data suggest there may be benefits. The objective of this study was to evaluate the influence of tracheostomy on mortality in both intensive care and hospital, and to study the role of pre-existing CRI.


METHODS
In a retrospective study of the records of 2901 patients admitted over a period of 5 years 882 were identified who had been intubated and ventilated. 127 patients who had had tracheostomies (T+) were compared with 755 who had not (T-), and with a sub-group of T- patients (T-app) matched for severity on admission (SAPSII).


RESULTS
ICU and hospital mortality were significantly less in the T+ than the T-patients (28 vs 52% and 42 vs 59%) and the duration of stay was longer. This was equally true when matched for severity on admission when T+ were compared with T app (28 vs 49% and 42 vs 59%). Pre-existing CRI did not influence the outcomes of the tracheostomised patients, regardless of whether the CRI was obstructive, restrictive or neuro-muscular.


CONCLUSIONS
Tracheostomy can, in certain groups of artificially ventilated patients and in certain care settings, be associated with a reduction in hospital mortality.
Cracco
C
C
Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Demoule
A
A
Harb
A
A
Taright
N
N
Lefort
Y
Y
Derenne
J-P
JP
Similowski
T
T
D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014139:Tracheostomy