PURPOSE: Tracheostomy is a common procedure performed in critically-ill patients in the intensive care units (ICU) for airway protection and long-term mechanical ventilation after failed attempts at extubation. Its use continues to increase globally despite debates about the proper timing and the correct identification of the patient population that will benefit the most from the procedure. There are also conflicting studies about the mortality benefits from the procedure. In addition, there is scarce data about the potential benefit of this procedure in allowing for rapid transfer of patients out of the intensive care units. The purpose of our study was to examine the effect of this procedure in expediting disposition to sub-acute facilities.
METHODS: This is a retrospective review of critically-ill patients admitted to the medical and surgical intensive care units at Emory University Hospital system. Data was obtained from our program database and hospital discharge records.
RESULTS: 62 patients (34 males; 44% with at least a single co-morbid condition) with a mean age of 57 underwent successful percutaneous tracheostomy at a mean of 18 days after hospital admission. Twenty-eight patients were discharged to LTAC at a mean of 19 days after the procedure. Eight patients were discharged to acute rehab at a mean of 27 days after the procedure. Seven patients were discharged to home at a mean of 26 days after the procedure. One patient was discharged home forty days after the procedure. Eighteen patients experienced death (10 from withdrawal of medical care, 5 from cardiac arrest and 3 from acute illness) at a mean of 14 days after the procedure prior to discharge from the ICU.
CONCLUSIONS: Percutaneous tracheostomy can be safely performed in the ICU and it led to a majority of patients being discharged from the ICU. There was a 4.8% mortality rate secondary to the patient’s underlying critical illness.
CLINICAL IMPLICATIONS: The implication of this study is the need to standardize the timing of tracheostomy in critically-ill patients.
DISCLOSURE: The following authors have nothing to disclose: Timothy Udoji, Cicely Ross, David Berkowitz, Rabih Bechara
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