ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2018 September;84(9):1024-31

DOI: 10.23736/S0375-9393.18.12133-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Mortality and long-term quality of life after percutaneous tracheotomy in Intensive Care Unit: a prospective observational study

Maria VARGAS ^{1, 2} ✉, Yuda SUTHERASAN ³, Iole BRUNETTI ¹, Camilla MICALIZZI ¹, Angelo INSORSI ¹, Lorenzo BALL ¹, Marta FOLENTINO ¹, Rosanna SILEO ¹, Arduino DE LUCIA ¹, Manuela CERANA ¹, Alessandro ACCATTATIS ¹, Domenico DE LISI ¹, Angelo GRATAROLA ⁴, Francesco MORA ⁵, Giorgio PERETTI ⁵, Giuseppe SERVILLO ², Paolo PELOSI ¹

¹ Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy; ² Department of Neurosciences, Reproductive and Odonthostomatologic Sciences, “Federico II” University, Naples, Italy; ³ Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; ⁴ Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy; ⁵ Department of Otorhinolaryngology, Head and Neck Surgery, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy

BACKGROUND: Quality of life and mortality after percutaneous dilatational tracheotomy (PDT) has been poorly investigated. The aims of this study were to evaluate the independent risk factors for Intensive Care Unit (ICU) mortality and investigate quality of life over the first year after PDT in critically ill patients.
METHODS: This was a prospective, single-center, cohort study performed in a tertiary care University Hospital, enrolling consecutive ICU patients requiring elective PDT, collecting data during the tracheotomy procedure and the ICU stay. Follow-up was performed at three, six and twelve months after PDT. The medical interview included the Euro Quality of Life questionnaire comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression).
RESULTS: A total of 137 patients were included in the study. In the multivariate analysis, ICU mortality was independently associated with age (OR 1.089; P=0.003) and SAPS II (OR 1.047; P=0.003), and inversely with neurologic disease (OR 0.162; P=0.004). Mortality increased over time (ICU mortality 26.7%; in-hospital mortality 43.1%; 3-months mortality 47.4%; 6-months mortality 61.3%; and 1-year mortality 70.8%; P=0.0001). Tracheostomized patients due to respiratory disease had a higher ICU mortality (50%) compared to those with neurological disease (13.6%). quality of life (QoL) of tracheostomized patients was severely compromised at 3-months (QoL: 17, 15-19), 6-months (QoL: 17; 16-19), while moderately compromised at 1-year (QoL: 13; 9-16). A subgroup analysis showed better QoL at 3-months, 6-months and 1-year in respiratory compared to neurological tracheostomized patients (P=0.01).
CONCLUSIONS: Patients baseline characteristics and indication for PDT procedure are important determinants of in-ICU mortality and QoL in tracheostomized patients.

KEY WORDS: Tracheotomy - Mortality, Follow-up studies - Quality of life - Intensive care units