PURPOSE:Patients requiring prolonged mechanical ventilation and tracheostomy have significant morbidity and mortality but there is limited data from the population perspective. Olmsted County, Minnesota, is one of the few places where one can conduct detailed studies of disease etiology and outcome in a defined geographic population.
METHODS:In this retrospective cohort study we reviewed electronic medical records from residents of Olmsted County, 18 years of age and older admitted to intensive care units at the two Mayo Clinic Rochester hospitals from January 1st 2006 to December 31st 2006, excluding those who denied research authorization, to identify patients who underwent tracheostomy for anticipated or prolonged mechanical ventilation and/or in whom multiple attempts to wean have been unsuccessful.
RESULTS:Among 1309 patients who were admitted to ICU 21 patients (12 men), underwent tracheostomy for prolonged mechanical ventilation resulting in incidence of 21 (95% CI 14–32) per 100,000 patient-years at risk. Median age (years) was 68.0 (IQR 41.5–80.5), with 29% of patients over the age of 80. The median number of days of mechanical ventilation before tracheostomy was 10.3 (IQR 6.6–15.6), with 71% of patients ventilated >21 days. Median hospital length of stay was 49.3 (IQR 32.5–70.2 days). Sixteen patients (76%) survived to hospital discharge and 12 (57%) were alive at one year follow up. The survival was similar in those ventilated more or less than 21 days (Figure 1, log rank p=0.58). Two patients, both with chronic neuromuscular disease, were continued on mechanical ventilation after hospital discharge.
CONCLUSION:There is a high incidence of prolonged mechanical ventilation in the community, with long term survival more favorable than in studies which included referral patients.
CLINICAL IMPLICATIONS:The need for prolonged mechanical ventilation in the community is high and does not preclude prolonged survival.
DISCLOSURE:Marija Kojicic, No Financial Disclosure Information; No Product/Research Disclosure Information