Association Between Tracheostomy and Functional, Neuropsychological, and Healthcare Utilization Outcomes in the RECOVER Cohort

Sangeeta Mehta, MD; Anita Brondani, MD; George Tomlinson, PhD; Leslie Chu, BSc; Stacey Burns, RN; Andrea Matte, BSc; Jill I. Cameron, PhD; Jan O. Friedrich, MD; Jill Rudkowski, MD; Priscila Robles, PhD; Yoanna Skrobik, MD; Margaret Herridge, MD; Neill K. J. Adhikari, MD; for the Canadian RECOVER Program Investigators and the Canadian Critical Care Trials Group (CCCTG)

doi:10.1097/CCE.0000000000000768

Critical Care Explorations (Oct 2022)

Association Between Tracheostomy and Functional, Neuropsychological, and Healthcare Utilization Outcomes in the RECOVER Cohort

Sangeeta Mehta, MD,
Anita Brondani, MD,
George Tomlinson, PhD,
Leslie Chu, BSc,
Stacey Burns, RN,
Andrea Matte, BSc,
Jill I. Cameron, PhD,
Jan O. Friedrich, MD,
Jill Rudkowski, MD,
Priscila Robles, PhD,
Yoanna Skrobik, MD,
Margaret Herridge, MD,
Neill K. J. Adhikari, MD,
for the Canadian RECOVER Program Investigators and the Canadian Critical Care Trials Group (CCCTG)

Affiliations

Sangeeta Mehta, MD: 1 Department of Medicine, Sinai Health System, Toronto, ON, Canada.
Anita Brondani, MD: 3 Department of Anesthesia and Critical Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
George Tomlinson, PhD: 4 Department of Medicine, University Health Network, Toronto, ON, Canada.
Leslie Chu, BSc: 6 Mackenzie Health Richmond Hill, Toronto, ON, Canada.
Stacey Burns, RN: 7 Toronto General Research Institute, Institute of Medical Science, University Health Network, Toronto, ON, Canada.
Andrea Matte, BSc: 7 Toronto General Research Institute, Institute of Medical Science, University Health Network, Toronto, ON, Canada.
Jill I. Cameron, PhD: 9 Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Jan O. Friedrich, MD: 11 Departments of Medicine and Critical Care Medicine, Unity Health-St. Michael’s Hospital, Toronto, ON, Canada.
Jill Rudkowski, MD: 13 St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
Priscila Robles, PhD: 15 Toronto General Research Institute, Institute of Medical Science, University Health Network, Toronto, ON, Canada.
Yoanna Skrobik, MD: 17 Department of Medicine, McGill University, Montreal, QC, Canada.
Margaret Herridge, MD: 18 Toronto General Research Institute, Institute of Medical Science, University Health Network, Toronto, ON, Canada.
Neill K. J. Adhikari, MD: 20 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
for the Canadian RECOVER Program Investigators and the Canadian Critical Care Trials Group (CCCTG)

DOI: https://doi.org/10.1097/CCE.0000000000000768
Journal volume & issue: Vol. 4, no. 10
p. e0768

Abstract

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OBJECTIVES:. Tracheostomy is commonly performed in critically ill patients requiring prolonged mechanical ventilation (MV). We evaluated the outcomes of tracheostomy in patients who received greater than or equal to 1 week MV and were followed for 1 year. DESIGN:. In this secondary analysis of a prospective observational study, we compared outcomes in tracheostomy versus nontracheostomy patients. Outcomes post ICU included Functional Independence Measure (FIM) subscales, 6-Minute Walk Test (6MWT), Short Form 36 (SF36), Medical Research Council (MRC) Scale, pulmonary function tests (PFTs), Impact of Event Scale (IES), Beck Depression Inventory-II (BDI-II), and vital status and disposition. SETTING:. Nine University affiliated ICUs in Canada. PATIENTS:. Medical/surgical patients requiring MV for 7 or more days who were enrolled in the Towards RECOVER Study. MEASUREMENTS AND MAIN RESULTS:. Of 398 ICU survivors, 193 (48.5%) received tracheostomy, on median ICU day 14 (interquartile range [IQR], 8–0 d). Patients with tracheostomy were older, had similar severity of illness, had longer MV duration and ICU and hospital stays, and had higher risk of ICU readmission (odds ratio [OR], 1.9; 95% CI, 1.0–3.2) and hospital mortality (OR, 2.6; 95% CI, 1.1–6.1), but not 1-year mortality (hazard ratio, 1.41; 95% CI, 0.88–1.2). Over 1 year, tracheostomy patients had lower FIM-Total (7.7 points; 95% CI, 2.2–13.2); SF36, IES, and BDI-II were similar. From 3 months, tracheostomy patients had 12% lower 6MWT (p = 0.0008) and lower MRC score (3.4 points; p = 0.006). Most PFTs were 5–8% lower in the tracheostomy group. Tracheostomy patients had similar specialist visits (rate ratio, 0.63; 95% CI, 0.28–2.4) and hospital readmissions (OR, 0.82; 95% CI, 0.54–1.3) but were less likely to be at home at hospital discharge and 1 year. CONCLUSIONS:. Patients who received tracheostomy had more ICU and hospital care and higher hospital mortality compared with patients who did not receive a tracheostomy. In 1 year follow-up, tracheostomy patients required a higher daily burden of care, expressed by FIM.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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