Abstract
BackgroundAcute respiratory distress syndrome (ARDS) is a life-threatening condition that often requires prolonged mechanical ventilation. Tracheostomy is a common procedure with some risks, on the other hand with potential advantages over orotracheal intubation in critically ill patients. This study investigated the association of tracheostomy with health-related quality of life (HRQoL), symptoms of psychiatric disorders and return-to-work of ARDS survivors.MethodsData were collected in the context of the prospective observational German-wide DACAPO study. Clinical and demographic patient data and treatment characteristics were obtained from the participating intensive care units (ICU). HRQoL and return-to-work were assessed using patient-reported questionnaires 3, 6 and 12 months after ICU discharge. HRQoL was measured with the Physical and Mental Component Scale of the Short-Form 12 Questionnaire (PCS-12, MCS-12). The prevalence of psychiatric symptoms (depression and post-traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire-9 and the Post-Traumatic Stress Syndrome-14. Physician-diagnosed anxiety and obsessive–compulsive disorder were recorded by patient self-report in the follow-up questionnaires. The associations of tracheostomy with HRQoL, psychiatric symptoms and return-to-work after 12 months were investigated by means of multivariable linear and logistic regression models.ResultsPrimary 877 ARDS patients (mean ± standard deviation: 54 ± 16 years, 68% male) survived and were discharged from ICU. Out of these patients, 478 (54.5%) were tracheotomised during ICU treatment. After 12 months, patient-reported outcomes could be analysed of 388 (44.2%) respondents, 205 with tracheostomy and 183 without. One year after ICU discharge, tracheostomy showed no significant association with physical or mental health-related quality of life (PCS-12: − 0.73 [− 3.96, 2.51]; MCS-12: − 0.71 [− 4.92, 3.49]), symptoms of psychiatric disorders (depression: 0.10 [− 1.43, 1.64]; PTSD: 3.31 [− 1.81, 8.43]; anxiety: 1.26 [0.41, 3.86]; obsessive–compulsive disorder: 0.59 [0.05, 6.68]) or return-to-work (0.71 [0.31, 1.64]) in the multivariable analysis (OR [95%-CI]).ConclusionsUp to 1 year after ICU discharge, neither HRQoL nor symptoms of psychiatric disorders nor return-to-work was affected by tracheostomy.Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered)
Highlights
Acute respiratory distress syndrome (ARDS), a lifethreatening condition characterised by direct or indirect damage to the lung parenchyma causing critical hypoxemia with or without hypercapnia [1]
Up to 1 year after intensive care unit (ICU) discharge, neither health-related quality of life (HRQoL) nor symptoms of psychiatric disorders nor return-towork was affected by tracheostomy
Healthcare research in critical care medicine is a relatively new field of interest focusing on the influence of organisational structures, the processes of care on mortality and health-related quality of life (HRQoL) of intensive care unit (ICU) survivors [2,3,4]
Summary
Acute respiratory distress syndrome (ARDS), a lifethreatening condition characterised by direct or indirect damage to the lung parenchyma causing critical hypoxemia with or without hypercapnia [1]. Prolonged endotracheal intubation results in acute laryngeal injuries in more than half of patients and is associated with significantly worse breathing and voicing up to 10 weeks after extubation [8]. Tracheostomy (TT), as the most commonly performed procedure in mechanically ventilated ICU patients, may increase patient comfort by reducing airway resistance and dead space and avoids potential intubation injuries such as oropharyngeal and laryngeal lesions. Acute respiratory distress syndrome (ARDS) is a life-threatening condition that often requires pro‐ longed mechanical ventilation. Tracheostomy is a common procedure with some risks, on the other hand with potential advantages over orotracheal intubation in critically ill patients. This study investigated the association of tracheostomy with health-related quality of life (HRQoL), symptoms of psychiatric disorders and return-to-work of ARDS survivors
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