Abstract
Data regarding the long-term outcomes for tracheostomized patients receiving home mechanical ventilation (HMV) are limited. We aimed to determine the 1-year mortality rate for critically ill tracheostomized patients with and without HMV. Data of tracheostomized patients between 1 January 2015 and 31 December 2019 were analyzed. A Kaplan-Meier analysis was performed to assess the survival curve of the patients. Among the 124 tracheostomized patients, 102 (82.3%) were weaned from mechanical ventilation (MV), and 22 (17.7%) required HMV at discharge. The overall 1-year mortality rate was 47.6%, and HMV group had a significantly higher 1-year mortality rate than those weaned from MV (41.2% vs. 77.3%, p = 0.002). In the Cox proportional hazards regression, BMI (HR 0.913 [95% CI 0.850–0.980], p = 0.012), Sequential Organ Failure Assessment (SOFA) score (HR 1.114 [95% CI 1.040–1.193], p = 0.002), transfer to a nursing facility (HR 5.055 [95% CI 1.558–16.400], p = 0.007), and HMV at discharge (HR 1.930 [95% CI 1.082–3.444], p = 0.026) were significantly associated with 1-year mortality. Critically ill tracheostomized patients with HMV at discharge had a significantly higher 1-year mortality rate than those weaned from MV. Low BMI, high SOFA score, transfer to a nursing facility, and HMV at discharge were significantly associated with 1-year mortality.
Highlights
Home mechanical ventilation (HMV) is used in patients with chronic respiratory failure, and the prevalence of HMV is increasing worldwide [1,2]
Low body mass index (BMI), high Sequential Organ Failure Assessment (SOFA) score, transfer to a nursing facility, and HMV at discharge were significantly associated with 1-year mortality
The percentage of HMV via tracheostomy users is very low in Western countries (3.1–18%) [1], the rate in Korea is reported to be as high as 63%, according to a nationwide study [3]
Summary
Home mechanical ventilation (HMV) is used in patients with chronic respiratory failure, and the prevalence of HMV is increasing worldwide [1,2]. A tracheostomy is a procedure that is performed for critically ill patients who are expected to require prolonged mechanical ventilation (MV) [4]. Patients who experience difficulty weaning off MV require HMV for prolonged ventilation [5]. Critical care is a limited resource, and occupancy of intensive care unit (ICU) beds for the purpose of prolonged weaning from MV leads to ICU overcrowding. In an observational study conducted at 55 ICUs, Li et al reported that one-fifth of the ICU beds were occupied by patients undergoing MV weaning for an extended period of time [6]
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