Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: A prospective, multicenter propensity analysis
Fernandez R, Tizon AI, Gonzalez J, Monedero P [SP], Garcia-Sanchez M, de-la-Torre MV, Ibañez P, Frutos F, Del-Nogal F, Gomez MJ, Marcos A, Hernández G; Sabadell Score Group.
From the Intensive Care Unit (RF), Hospital Sant Joan de Deu- Fundacio Althaia, Manresa; Universitat Internacional de Catalunya (RF), Catalunya; Intensive Care Unit (AIT), Hospital Xeral Cies, Vigo; Intensive Care Unit (JG), Hospital de Salamanca, Salamanca; Intensive Care Unit (PM), Clinica Universidad de Navarra, Navarra; Intensive Care Unit (MGS), Hospital Universitario Virgen Macarena, Sevilla; Intensive Care Unit (MVDLT), Hospital Virgen de la Victoria, Malaga; Intensive Care Unit (PI), Hospital Son Llatzer, Mallorca; Intensive Care Unit (FF), Hospital Universitario de Getafe, Getafe; CIBER Enfermedades Respiratorias (FF), Bunyola; Intensive Care Unit (FDN), Hospital Severo Ochoa, Leganes; Intensive Care Unit (MJG), Hospital General Universitario Reina Sofia, Murcia; Intensive Care Unit (AM), Hospital Virgen de la Concha, Zamora; and Intensive Care Unit (GH), Hospital Infanta Sofia, San Sebastian de los Reyes, Spain
Magazine: Critical Care Medicine
Date: Jun 10, 2011Anesthesia and Intensive Care [SP]
To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions.
Prospective, observational survey.
Thirty-one intensive care units throughout Spain.
All patients admitted from March 1, 2008 to May 31, 2008.
MEASUREMENTS AND MAIN RESULTS
At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival.
Statistics: Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place.
Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3-1.2] (p = .1).
In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.
CITATION Crit Care Med. 2011 Jun 10
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