Pulmonary Rehabilitation: Pulmonary Rehabilitation |

Planning for Tracheostomy? Time to Revisit Goals of Care FREE TO VIEW

Catherine Allen, MD; Adel Bassily-Marcus, MD; Taylor Moran-Gates, MD; Talia Helman; Anthony Manasia, MD; John Oropello, MD; Roopa Kohli-Seth, MD
Author and Funding Information

Mount Sinai Medical Center, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1118A. doi:10.1016/j.chest.2016.08.1227
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SESSION TITLE: Pulmonary Rehabilitation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Studies evaluating the outcome of patients receiving tracheostomy are scarce and conflicting. Some reported patients who receive tracheostomy had improved survival, while others showed that tracheostomy has no positive impact on overall survival. These discrepancies explain the lack of consensus on outcomes that can guide families to make a fully informed decision

METHODS: Retrospective chart review of all patients who received a new tracheostomy during surgical intensive care unit stay (SICU) of a tertiary academic medical center between January 1, 2012 and July 1st, 2015. Thirty day survival post SICU was determined.

RESULTS: A total of 173 patients received tracheostomy in the study period. 66 (38.2%) patients died within 30 days of hospital discharge. Average ICU length of stay (LOS) 32.6 days and average hospital LOS 72.2 days. 101 of the patients had percutaneous tracheostomy (62.4%), mortality rate for percutaneous technique 38.6 %, vs. open 37.5 % (p < 0.05). There have been no mortality related to the procedure.

CONCLUSIONS: Patients who required tracheostomy during their SICU stay had high 30 day mortality, prolonged ICU and hospital stay. Procedure technique had no influence on outcome. Incorporating this outcome data into the goals of care discussion prior to the procedure is critical in guiding families to obtain a well informed decision.

CLINICAL IMPLICATIONS: This data demonstrates high mortality rate and long ICU and hospital stay amongst patients who receive tracheostomy. This objective analysis could be a reference to improve patient selection and tracheostomy utilization particularly towards the end of life.

DISCLOSURE: The following authors have nothing to disclose: Catherine Allen, Adel Bassily-Marcus, Taylor Moran-Gates, Talia Helman, Anthony Manasia, John Oropello, Roopa Kohli-Seth

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