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Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients
Author(s) -
Patel Sapna A.,
Plowman Emily K.,
Halum Stacey,
Merati Albert L.,
Sardesai Maya G.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25322
Subject(s) - tracheotomy , medicine , mechanical ventilation , odds ratio , retrospective cohort study , confidence interval , surgery , prospective cohort study , ventilation (architecture) , anesthesia , mechanical engineering , engineering
Objectives/Hypothesis To determine whether the timing of tracheotomy placement impacts ventilation weaning status and mortality. Study Design Multi‐institution retrospective cohort study. Methods Demographic data, procedural details, and clinical outcomes were recorded for patients undergoing tracheotomy for prolonged mechanical ventilation across eight sites. The study group was divided into two groups: those undergoing tracheotomy within 14 days of initiation of mechanical ventilation and those undergoing tracheotomy at or after 14 days. Groups were compared for primary outcome measures of mortality and ability to wean from mechanical ventilation within the study period. Results Of the 539 patients intubated for ventilator dependence with complete data available, 280 (51.9%) underwent tracheotomy within 14 days. Patients who underwent late tracheotomy were 1.72 times more likely to remain ventilator dependent during the follow‐up period (95% confidence interval [CI]: 1.12‐2.66), and had a 40% increased risk of death (odds ratio: 1.4, 95% CI: 0.96‐1.99). Conclusions In this multicenter retrospective review of tracheotomy outcomes, late tracheotomy placement (>14 days) was associated with increased mortality and prolonged ventilator dependence. Standardized multidisciplinary management protocols for prolonged mechanical ventilation are recommended, and future work should confirm these results in a prospective manner. Level of Evidence 4 Laryngoscope , 125:2134–2138, 2015