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Long-Term Survival of Patients with Tracheostomy Having Different Diseases Followed up in the Respiratory Intensive Care Unit Outpatient Clinic: Which Patients are Lucky?

OBJECTIVES
Tracheostomy is a method of separating a patient from the mechanical ventilator in the intensive care unit (ICU). The long-term survivors among patients followed up with tracheostomy and ventilator in the respiratory ICU (RICU) outpatient clinic due to different diseases were investigated.


MATERIALS AND METHODS
This was a retrospectively designed cohort study between January 2004 and July 2018. Patients with chronic respiratory failure followed up with tracheostomy and/or ventilator at the RICU outpatient clinic were included in the study. Age, gender, indications and date of tracheostomy, use of domestic mechanical ventilation, and mortality were recorded. The groups were compared according to age, gender, and tracheostomy indication diseases, and the 1-3-year long-term mortality rates were analyzed by the Kaplan-Meier survival analysis, and the Cox regression test was performed.


RESULTS
A total of 134 (64% male) patients with a median age of 66 (54-73) years were included in the study. The indications for tracheostomy were heart failure (HF) and cerebrovascular diseases (38.1%), chronic obstructive pulmonary disease (COPD) (23.1%), neuromuscular diseases (22.4%), obesity hypoventilation (9.7%), and kyphoscoliosis (6.7%). Mortality was higher in patients >75 years old in the 3-year follow-up (p=0.022). The 3-year mortality hazard ratio (HR) factors and 95% confidence interval (CI) were as follows: age >75 years HR=1.71 (95% CI, 1.03-2.82; p<0.036) and HF and cerebrovascular disease diseases sequela HR=1.84 (95% CI, 1.03-3.29; p<0.041) significantly increased the 3-year mortality, and having COPD decreased mortality in 46% (p<0.041).


CONCLUSION
Patients with neuromuscular disorders, kyphoscoliosis, and COPD who have undergone tracheostomy were the luckiest group according to the 3-year survival rates, whereas patients with HF and cerebrovascular diseases were the unluckiest ones. The most important decision triangle is the patient's acceptance (A), family support (B), and tracheostomy indication (C), and this may vary from country to country depending on the beliefs of subjects.