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Long-term survival in patients with tracheostomy and prolonged mechanical ventilation in Olmsted County, Minnesota
Marija Kojicic1, Guangxi Li, Adil Ahmed
1Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Background:
An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective.
Methods:
We retrospectively reviewed the electronic medical records of adult Olmsted county, Minnesota, residents admitted to the intensive care units at the 2 Mayo Clinic Rochester hospitals from January 1, 2003, to December 31, 2007, who underwent tracheostomy for PMV.
Results:
Sixty-five patients, median age 68 years (interquartile range [IQR] 49-80 y), 39 male, underwent tracheostomy for PMV, resulting in an age-adjusted incidence of 13 (95% CI 10-17) per 100,000 patient-years at risk. The median number of days on mechanical ventilation was 24 days (IQR 18-37 d). Forty-six patients (71%) survived to hospital discharge, and 36 (55%) were alive at 1-year follow-up. After adjusting for age and baseline severity of illness, the presence of COPD was independently associated with 1-year mortality (hazard ratio 3.4, 95% CI 1.4-8.2%).
Conclusions:
There was a considerable incidence of tracheostomy for PMV. The presence of COPD was an independent predictor of 1-year mortality.
Insights
Prolonged mechanical ventilation (PMV) via tracheostomy occurs frequently in the community. Chronic obstructive pulmonary disease (COPD) independently predicts 1-year mortality in these patients.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Epidemiology
Background:
- Prolonged mechanical ventilation (PMV) is associated with significant morbidity and mortality.
- Community-based data on PMV incidence and outcomes are limited.
Purpose of the Study:
- To determine the incidence and outcomes of PMV requiring tracheostomy in a community setting.
- To identify predictors of mortality in patients undergoing tracheostomy for PMV.
Main Methods:
- Retrospective review of electronic medical records for adult residents of Olmsted County, Minnesota.
- Analysis of patients undergoing tracheostomy for PMV between 2003 and 2007.
- Statistical adjustment for age and baseline illness severity.
Main Results:
- An age-adjusted incidence of 13 per 100,000 patient-years for tracheostomy for PMV was observed.
- Median ventilation duration was 24 days, with 71% surviving to discharge and 55% alive at 1-year.
- Chronic obstructive pulmonary disease (COPD) was independently associated with increased 1-year mortality (HR 3.4).
Conclusions:
- Tracheostomy for PMV occurs with considerable incidence in the general community.
- COPD is a significant independent predictor of 1-year mortality in patients requiring PMV.
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