Risk factors for 90-day mortality in critically ill ICU patients who undergo a tracheostomy. Frailty: A matter of great concern

Abstract

ObjectiveTracheostomy (TR) remains one of the most performed procedures in the Intensive Care Unit (ICU). The literature normally focusses on technical issues and its timing; however, it is important to identify modifiable factors that increase the risk of mortality. DesignProspective cohort study between October 2013 and April 2019. SettingICU in a University Hospital in Spain. PatientsAdmitted to the ICU who underwent a TR during their ICU stay. InterventionsNone. MeasurementsMain comorbidities, baseline frailty status, severity scores, and variables related to mechanical ventilation (MV), TR weaning, decannulation, and mortality. ResultsA total of 3010 admissions were identified; 212 (7%) underwent TR during their ICU stay. The final cohort comprised 135 patients. Median age was 69.6 (61.5–77.4) years; prevalence of frailty was 17.8%. Median time of MV before TR was 8.3 (5.3–11.1) days. All-cause 90-day mortality was 49.6%. Age, severity of illness, the impossibility of attempting a spontaneous breathing (SB) trial, SB time less than 50% of the time with TR, and TR in place at ICU discharge were independent predictors of 90-day mortality. The 90-day mortality rate was 2.2-fold higher in frail (Clinical Frailty Scale, CFS≥5), tracheostomized patients. ConclusionsFrailty (CFS≥5), the inability of maintaining SB for more than 50% of the time with TR and discharge from ICU with TR in place were independent predictors of 90-day mortality. The creation of a surveillance team focusing on frail and non-decannulated patients to decrease 90-day mortality warrants further investigation.