Tracheostomy Practices for Mechanically Ventilated Patients in Malawi

Area of Science:

• Critical Care Medicine
• Global Health
• Surgical Procedures

Background:

• Tracheostomy is crucial for prolonged mechanical ventilation, yet its utilization in low- and middle-income countries remains under-researched.
• Sub-Saharan Africa, in particular, lacks extensive data on tracheostomy practices and outcomes.

Purpose of the Study:

• To investigate the impact of tracheostomy on hospital mortality in a tertiary hospital intensive care unit (ICU) in Malawi.
• To conduct a subgroup analysis focusing on patients with severe head injuries.

Main Methods:

• A prospective cohort study involving 451 patients admitted to the ICU between September 2016 and July 2018.
• Comparison of hospital mortality between patients who received tracheostomy and those who did not.
• Logistic regression and standardized mortality ratio weighting for outcome analysis.

Main Results:

• Overall hospital mortality was lower in patients who received tracheostomy (40%) compared to those who did not (63%) (OR 0.34, p < 0.001).
• Standardized mortality ratio weighting also indicated reduced hospital death with tracheostomy (OR 0.81, p < 0.001).
• In the severe head injury subgroup, tracheostomy was not associated with a significant difference in hospital mortality (OR 1.28, p = 0.104).

Conclusions:

• Tracheostomy is not significantly associated with hospital mortality in this Malawian ICU cohort, with findings influenced by severe head injuries.
• The study highlights the need for research into home tracheostomy care due to limited discharge options in austere settings.