1 Outcomes of tracheostomy patients using an interdisciplinary care model (retrospective cohort)

Abstract

Background There are no national data regarding outcomes of tracheostomy patients. The aim of this study was to examine the outcomes of tracheostomy inpatients at KAMC-Jeddah using an interdisciplinary care model. The objectives were to identify the proportion of tracheostomy patients with successful decannulation, estimate the time to decannulation post intensive care unit (ICU) discharge, and to identify the predictors of weaning trials failure. Methods This study had a retrospective cohort design in which all tracheostomy patients from January 2016 until December 2018 were included. Pediatric patients and those with neck tumors obstructing the airway were excluded. Data regarding patients' demographics, comorbidities, GCS, and ICU discharge and decannulation dates were collected. Tracheostomy patients were assessed weekly during team rounds by all team members (respiratory therapist, speech clinician, ENT doctor, rehab medicine doctor, tracheostomy resource nurse). Results The cohort included 221 patients, of whom 36 were chronic tracheostomy patients. Of the 185 patients who underwent weaning trials, 71 (38%) were successfully weaned and decannulated; the median time to decannulation post ICU discharge was 46.5 days. Predictors of weaning trials failure were number of comorbidities (odd ratio [OR] 2.635, 95% CI 1.4-5.0, p<0.01), GCS score <11 (OR 6, 95% CI 2.7-13.9, p<0.01), female sex (OR 3.1, 95% CI 1.3-7.5, p<0.01), and age (OR 1.04, 95% CI 1.02-1.06, p<0.01). All decannulation attempts were safe and successful, and none of the 40 inpatient deaths (18%) were related to tracheostomy. Conclusion The majority of tracheostomy patients had prolonged hospital stay. The interdisciplinary care model ensured the safety of their weaning/decannulation process and improved the quality of their hospital care.