Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Data Collection and Definitions
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Outcomes of Patients Who Received a Tracheostomy
3.3. Predictive Factors for 1-Year Mortality
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total (n = 124) | No HMV (n = 102) | HMV (n = 22) | p Value |
---|---|---|---|---|
Age (years) | 77 (68–82) | 76 (69–82) | 78 (66–83) | 0.094 |
Male (%) | 69 (55.6) | 55 (53.9) | 14 (63.6) | 0.405 |
Body mass index (kg/m2) | 20.8 (18.4–24.4) | 20.8 (18.5–24.3) | 20.5 (17.7–24.5) | 0.014 |
Before admission (%) | ||||
Nursing home or hospital | 29 (23.4) | 26 (25.5) | 3 (13.6) | 0.234 |
Bedridden status | 29 (23.4) | 26 (25.5) | 3 (13.6) | 0.234 |
Tube feeding | 29 (23.4) | 24 (23.5) | 5 (22.7) | 0.936 |
SOFA score | 8.5 (6–11) | 8 (5–11) | 9 (7–11) | 0.014 |
ProVent 14 score | 2 (2–2) | 2 (2–2) | 2 (2–3) | 0.096 |
Charlson Comorbidity Index | 4 (3–5) | 4 (3–5) | 3.5 (3–5) | 0.383 |
Comorbidities (%) | ||||
Diabetes | 11 (8.9) | 7 (6.9) | 4 (18.2) | 0.105 |
Hypertension | 12 (9.7) | 9 (8.8) | 3 (13.6) | 0.445 |
Chronic lung disease | 12 (9.7) | 6 (5.9) | 6 (27.3) | 0.007 |
Chronic kidney disease | 6 (4.8) | 3 (2.9) | 3 (13.6) | 0.068 |
Chronic liver disease | 2 (1.6) | 2 (2.0) | 0 (0.0) | 1.000 |
Cardiovascular disorder | 24 (19.4) | 19 (18.6) | 5 (22.7) | 0.766 |
Neurological disorder | 30 (24.2) | 25 (24.5) | 5 (22.7) | 1.000 |
Malignancy | 6 (4.8) | 6 (5.9) | 0 (0.0) | 0.590 |
Admission via ER (%) | 109 (87.9) | 92 (90.2) | 17 (77.3) | 0.141 |
Reason for ICU admission (%) | 0.163 | |||
Sepsis/septic shock | 18 (14.5) | 16 (15.7) | 2 (9.1) | |
Pneumonia | 42 (33.9) | 38 (37.3) | 4 (18.2) | |
Cardiovascular disease | 5 (4.0) | 5 (4.9) | 0 (0.0) | |
ARDS/acute respiratory failure | 13 (10.5) | 10 (9.8) | 3 (13.6) | |
Post-cardiac arrest care | 35 (28.2) | 26 (25.5) | 9 (40.9) | |
Other | 11 (8.9) | 7 (6.9) | 4 (18.2) | |
Tracheostomy type (%) | 0.184 | |||
Surgical tracheostomy | 91 (73.4) | 72 (70.6) | 19 (86.4) | |
Percutaneous dilatational tracheostomy | 33 (26.6) | 30 (29.4) | 3 (13.6) | |
Initial vital signs | ||||
Systolic blood pressure (mmHg) | 94 (87–107) | 94 (87–106) | 95.5 (90–110) | 0.739 |
Diastolic blood pressure (mmHg) | 54 (48–60) | 54 (48–59) | 54 (46–65) | 0.622 |
Heart rate (/min) | 94 (82–110) | 94 (80–106) | 108 (88–126) | 0.499 |
Respiratory rate (/min) | 22.5 (20–26) | 22 (20–26) | 24 (19–28) | 0.725 |
Body temperature (°C) | 36.7 (36.4–37.2) | 36.7 (36.5–37.2) | 36.7 (36.2–37.2) | 0.068 |
Oxygen saturation (%) | 97 (95–99) | 97 (95–99) | 97 (94–99) | 0.762 |
Glasgow coma scale | 7 (5–10) | 7 (5–10) | 7 (5–10) | 0.834 |
PaO2/FiO2 | 171 (94–254) | 177 (99–258) | 153 (74–274) | 0.149 |
Time of MV to tracheostomy (days) | 13 (8–17) | 13 (8–18) | 13 (10–15) | 0.272 |
Vasopressor (%) | 63 (50.8) | 50 (49.0) | 13 (59.1) | 0.391 |
CRRT (%) | 18 (14.5) | 12 (11.8) | 6 (27.3) | 0.090 |
Neuromuscular blocker (%) | 10 (8.1) | 7 (6.9) | 3 (13.6) | 0.383 |
Laboratory findings | ||||
White blood cells (×109/L) | 12.4 (8.3–17.0) | 13.1 (8.4–16.9) | 10.3 (8.3–20.6) | 0.296 |
Platelet (×109/L) | 226 (161–308) | 225 (162–295) | 228 (132–355) | 0.647 |
Albumin (g/dL) | 3.0 (2.6–3.5) | 3.0 (2.5–3.5) | 3.2 (2.8–3.4) | 0.029 |
Creatinine (mg/dL) | 0.91 (0.57–1.47) | 0.87 (0.55–1.46) | 1.04 (0.70–2.25) | 0.079 |
C-reactive protein (mg/dL) | 94 (16–182) | 87 (17–177) | 110 (11–229) | 0.074 |
Lactic acid (mmol/L) | 1.9 (1.0–3.5) | 1.9 (1.0–3.8) | 1.6 (1.1–2.4) | 0.371 |
At discharge (%) | ||||
Nursing home or hospital | 100 (80.6) | 78 (76.5) | 22 (100.0) | 0.007 |
Tube feeding | 94 (75.8) | 72 (70.6) | 22 (100.0) | 0.003 |
Decannulation of tracheostomy tube | 25 (20.2) | 25 (24.5) | 0 (0.0) | 0.007 |
Length of hospital stay (days) | 68 (42–106) | 72 (42–106) | 62 (40–112) | 0.136 |
Duration of ICU stay (days) | 29 (21–52) | 26 (18–43) | 52 (31–67) | 0.228 |
Duration of MV (days) | 22 (13–34) | 19 (12–29) | 33 (26–52) | 0.082 |
Duration of MV and HMV (days) | 23 (13–46) | 19 (12–29) | 75 (52–102) | 0.034 |
Variables | Total (n = 124) | No HMV (n = 102) | HMV (n = 22) | p Value |
---|---|---|---|---|
Primary outcome | ||||
1-yr mortality (%) | 59 (47.6) | 42 (41.2) | 17 (77.3) | 0.002 |
Secondary outcomes | ||||
3-m mortality (%) | 29 (23.4) | 21 (20.6) | 8 (36.4) | 0.162 |
6-m mortality (%) | 44 (35.5) | 31 (30.4) | 13 (59.1) | 0.014 |
Variables | Univariate Analysis | Multivariable Analysis | ||
---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | |
Age | 1.009 (0.989–1.029) | 0.388 | ||
Male | 1.694 (0.993–2.889) | 0.053 | ||
Body mass index | 0.917 (0.856–0.982) | 0.013 | 0.913 (0.850–0.980) | 0.012 |
Bedridden status before admission | 1.150 (0.640–2.066) | 0.641 | ||
Tube feeding before admission | 1.314 (0.740–2.332) | 0.352 | ||
SOFA score | 1.080 (1.011–1.154) | 0.023 | 1.114 (1.040–1.193) | 0.002 |
ProVent 14 score | 1.204 (0.881–1.644) | 0.244 | ||
Charlson Comorbidity Index | 1.115 (0.971–1.279) | 0.123 | ||
Vasopressor | 1.772 (1.048–2.995) | 0.033 | ||
CRRT | 2.113 (1.139–3.918) | 0.018 | ||
Neuromuscular blocker | 1.815 (0.823–4.004) | 0.140 | ||
Transferred to a nursing facility | 6.156 (1.925–19.684) | 0.002 | 5.055 (1.558–16.400) | 0.007 |
Tube feeding at discharge | 4.733 (1.891–11.843) | 0.001 | ||
Decannulation of tracheostomy tube | 0.362 (0.156–0.843) | 0.018 | ||
HMV at discharge | 2.560 (1.453–4.510) | 0.001 | 1.930 (1.082–3.444) | 0.026 |
Length of hospital stay | 0.997 (0.993–1.001) | 0.171 | ||
Duration of ICU stay | 1.006 (0.996–1.015) | 0.227 | ||
Duration of MV and HMV | 1.004 (1.000–1.008) | 0.032 | ||
Time from MV to tracheostomy | 0.993 (0.977–1.009) | 0.361 | ||
PaO2/FiO2 | 0.999 (0.997–1.001) | 0.315 | ||
Albumin | 0.619 (0.406–0.946) | 0.027 |
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Kim, W.-Y.; Baek, M.S. Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge. J. Pers. Med. 2021, 11, 1257. https://doi.org/10.3390/jpm11121257
Kim W-Y, Baek MS. Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge. Journal of Personalized Medicine. 2021; 11(12):1257. https://doi.org/10.3390/jpm11121257
Chicago/Turabian StyleKim, Won-Young, and Moon Seong Baek. 2021. "Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge" Journal of Personalized Medicine 11, no. 12: 1257. https://doi.org/10.3390/jpm11121257
APA StyleKim, W.-Y., & Baek, M. S. (2021). Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge. Journal of Personalized Medicine, 11(12), 1257. https://doi.org/10.3390/jpm11121257