title: Prognostic indicators for early mortality after tracheostomy in the intensive care unit.
abstract: Tracheostomy is indicated for patients requiring prolonged mechanical ventilation. The aim of this study is to identify prognostic indicators for early mortality after tracheostomy to potentially avoid futility in the intensive care unit.
  
  
  
  Patients who underwent tracheostomy and died within 30 d of admission (futile group) were compared with patients who underwent tracheostomy and survived more than 30 d after admission (nonfutile group). Categorical data were analyzed using chi-square and Fisher's exact tests. Continuous variables were analyzed using T-tests and Mann-Whitney U tests. Prognostic factors were evaluated with univariable and multivariable logistic regression analyses.
  
  
  
  Overall, 88.3% of patients underwent nonfutile tracheostomy, while 11.7% underwent futile tracheostomy. Serum albumin level (1.5 g/dL versus 1.9 g/dL, P = 0.040) and mechanical ventilation duration before procedure (10 versus 12 d, P = 0.029) were significantly less in the futile group. Hypoalbuminemia (<2 g/dL) and preoperative mechanical ventilation ≤10 d were also predictive of futile tracheostomy in multivariable analysis.
  
  
  
  Hypoalbuminemia may serve as a prognostic indicator and risk factor for early mortality after tracheostomy. In patients with hypoalbuminemia, treatment of underlying disease processes and trending serum albumin level recovery in response to treatment may provide some insight to clinicians with regard to timing of tracheostomy. Better prognostic tools are still needed for critically ill patients to avoid futility in the intensive care unit. In this cohort, 88.3% of patients undergoing tracheostomy survived past 30 d.
authors.affiliation: Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania.
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsikia
authors.affiliation: Department of Surgery, University of Toledo Medical Center, Toledo, Ohio.
authors.forename: Matthew
authors.initials: M
authors.lastname: Goodwin
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Wells
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Gauthier
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Molli
authors.initials: M
authors.lastname: Bascom
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Moon
authors.initials: M
authors.lastname: Suh
authors.affiliation: Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
authors.forename: Beth
authors.initials: B
authors.lastname: Meloro
authors.affiliation: Department of Surgery, University of Toledo Medical Center, Toledo, Ohio.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
authors.affiliation: Department of Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania. Electronic address: joshiam@einstein.edu.
authors.forename: Amit R T
authors.initials: ART
authors.lastname: Joshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000175:diagnosis; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000401:mortality*; D055815:Young Adult
keywords: Critically ill; Futility; Hypoalbuminemia; Tracheostomy