Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient's vulnerability.
OBJECTIVE
To determine the effect of discharge from the ICU with a tracheostomy tube on ward mortality and its relation to patient vulnerability.


METHODS
Retrospective single-center cohort study.


METHODS
Database (2003-2006) review of patients undergoing mechanical ventilation (MV) > 24 h and discharged from the ICU with or without tracheostomy tube in place and followed up to hospital discharge or death. We recorded clinical characteristics, complications, major ICU procedures, subjective prognosis at ICU discharge (Sabadell score), and hospital outcome. Factors associated with ward mortality were analyzed by multiple logistic regression.


RESULTS
From 3,065 patients admitted to the ICU, 1,502 needed MV > 24 h. Only 936 patients (62%) survived the ICU and were transferred to the ward; of these, 130 (13.9%) had a tracheostomy tube in place. Ward mortality was higher in patients with a tracheostomy tube in place than in those without (26 vs. 7%, P < 0.001). Increased ward mortality among cannulated patients was seen only in those with intermediate Sabadell score (24 vs. 9% in score 1, P = 0.02, and 38 vs. 24% in score 2, P = 0.06), but not in the "good prognosis" (2 vs. 2%, score 0) and "expected to die in hospital" (80 vs. 75%, score 3) groups. Multivariate analysis found three factors associated with ward mortality: age, tracheostomy tube in place, and Sabadell score.


CONCLUSIONS
Lack of tracheostomy decannulation in the ICU appears to be associated with ward mortality, but only in the group with a Sabadell score of 1.
Critical Care Center, Hospital de Sabadell, CIBERES, Parc Taulí s/n., 08208 Sabadell, Spain. rfernandez@tauli.cat
Rafael
R
Fernandez
Nestor
N
Bacelar
Gonzalo
G
Hernandez
Isabel
I
Tubau
Francisco
F
Baigorri
Gisela
G
Gili
Antonio
A
Artigas
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D014139:Tracheostomy / Q000401:mortality*