M J Mpe1, B V Mphahlele. 1. Department of Medicine, Division of Pulmonology and Critical Care, Medical University of Southern Africa, PO Box 105, Medunsa, 0204.
Abstract
OBJECTIVE: To document the outcome of patients discharged from the intensive care unit (ICU) with tracheostomies. DESIGN AND SETTING: This was a retrospective study conducted in the ICU of Dr George Mukhari Hospital, Pretoria. PATIENTS: All patients discharged from the ICU with tracheostomies over a period of 1 year from 1 January to 31 December 2003. INTERVENTIONS: None. MEASUREMENTS: The main variables studied were post-ICU mortality and length of hospital stay, the Glasgow Coma Scale (GCS) at discharge from ICU and the multiple organ dysfunction score on the day of discharge from the ICU. MAIN RESULTS: Forty-seven patients were discharged with tracheostomies during the study period. The post-ICU mortality was 57%. The mortality of patients discharged with a GCS below 8 was statistically higher than that of patients discharged with a GCS above 8 (79% v. 22%, p = 0.0002). Survivors had significantly longer duration of hospitalisation (26.95 +/- 21.47 days v. 13.48 +/- 14.24 days, p = 0.021) than non-survivors. The mortality rate was higher if the tracheostomy was performed for a low GCS than when it was performed for reasons other than a low GCS (p = 0.0001). The 20 surviving patients were decannulated before discharge from hospital. CONCLUSION: The outcome of patients discharged from the ICU with tracheostomies is, on the whole, unfavourable compared with predicted mortality. A GCS of less than 8 is a good predictor of poor outcome.
OBJECTIVE: To document the outcome of patients discharged from the intensive care unit (ICU) with tracheostomies. DESIGN AND SETTING: This was a retrospective study conducted in the ICU of Dr George Mukhari Hospital, Pretoria. PATIENTS: All patients discharged from the ICU with tracheostomies over a period of 1 year from 1 January to 31 December 2003. INTERVENTIONS: None. MEASUREMENTS: The main variables studied were post-ICU mortality and length of hospital stay, the Glasgow Coma Scale (GCS) at discharge from ICU and the multiple organ dysfunction score on the day of discharge from the ICU. MAIN RESULTS: Forty-seven patients were discharged with tracheostomies during the study period. The post-ICU mortality was 57%. The mortality of patients discharged with a GCS below 8 was statistically higher than that of patients discharged with a GCS above 8 (79% v. 22%, p = 0.0002). Survivors had significantly longer duration of hospitalisation (26.95 +/- 21.47 days v. 13.48 +/- 14.24 days, p = 0.021) than non-survivors. The mortality rate was higher if the tracheostomy was performed for a low GCS than when it was performed for reasons other than a low GCS (p = 0.0001). The 20 surviving patients were decannulated before discharge from hospital. CONCLUSION: The outcome of patients discharged from the ICU with tracheostomies is, on the whole, unfavourable compared with predicted mortality. A GCS of less than 8 is a good predictor of poor outcome.