Tracheostomy and long-term mortality in ICU patients undergoing prolonged mechanical ventilation

• Published in: PloS one 2019-10, Vol.14 (10), p.e0220399-e0220399
• Main Authors: Cinotti, Raphaël, Voicu, Sebastian, Jaber, Samir, Chousterman, Benjamin, Paugam-Burtz, Catherine, Oueslati, Haikel, Damoisel, Charles, Caillard, Anaïs, Roquilly, Antoine, Feuillet, Fanny, Mebazaa, Alexandre, Gayat, Etienne
• Format: Article
• Language: English
• Subjects: Adult; Aged; Critical care; Critically ill persons; Dependent variables; Epidemiology; Female; Follow-Up Studies; Health aspects; Heart failure; Hospital Mortality; Hospital patients; Hospitals; Humans; Intensive care; Intensive Care Units; Length of Stay; Life Sciences; Male; Mechanical ventilation; Medicine and Health Sciences; Middle Aged; Mortality; Observational studies; Ostomy; Prospective Studies; Quality of life; Regression models; Research and Analysis Methods; Respiration, Artificial; Respiratory distress syndrome; Statistical analysis; Studies; Systematic review; Time dependence; Tracheostomy; Ventilation; Ventilators; Weaning
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0220399

In critically ill patients undergoing prolonged mechanical ventilation (MV), the difference in long-term outcomes between patients with or without tracheostomy remains unexplored. Ancillary study of a prospective international multicentre observational cohort in 21 centres in France and Belgium, including 2087 patients, with a one-year follow-up after admission. We included patients with a MV duration ≥10 days, with or without tracheostomy. We explored the one-year mortality with a classical Cox regression model (adjustment on age, SAPS II, baseline diagnosis and withdrawal of life-sustaining therapies) and a Cox regression model using tracheostomy as a time-dependant variable. 29.5% patients underwent prolonged MV, out of which 25.6% received tracheostomy and 74.4% did not. At one-year, 45.2% patients had died in the tracheostomy group and 51.5% patients had died in the group without tracheostomy (p = 0.001). In the Cox-adjusted regression model, tracheostomy was not associated with improved one-year outcome (HR CI95 0.7 [0.5-1.001], p = 0.051), as well as in the model using tracheostomy as a time-dependent variable (OR CI 95 1 [0.7-1.4], p = 0.9). In our study, there was no statistically significant difference in the one-year mortality of patients undergoing prolonged MV when receiving tracheostomy or not. NCT01367093.