Earlier tracheostomy is associated with an earlier return to walking, talking, and eating

Loading...
Thumbnail Image
File version

Accepted Manuscript (AM)

Author(s)
Sutt, AL
Tronstad, O
Barnett, AG
Kitchenman, S
Fraser, JF
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
2020
Size
File type(s)
Location
Abstract

Background: Conjecture remains regarding the optimal timing for tracheostomy. Most studies examine patient mortality, ventilation duration, intensive care unit (ICU) length of stay, and medical complications. Few studies examine patient-centric outcomes. The aim of this study was to determine whether timing of tracheostomy had an impact on length of stay, morbidity, mortality, and patient-centric outcomes towards their functional recovery. Methods: This prospective observational study included data for all tracheostomised patients over 4 y in a tertiary ICU. The study time period commenced with the insertion of an endotracheal tube. Data collected included patient and disease specifics; mortality up to 4 y; mobility scores; and time to oral intake, talking, and out-of-bed exercises. To assess differences between timing of tracheostomy, a survival analysis was conducted to dynamically compare patients on days before and after tracheostomy tube (TT) placement during their ICU admission. Results: TT was placed in 276 patients. After tracheostomy, the patients were able to (on average) verbally communicate 7.4 d earlier (confidence interval [CI] = -9.1 to −4.9), return to oral intake 7.0 d earlier (CI = -10 to −4.6), and perform out-of-bed exercises 6.2 d earlier (CI = -8.4 to −4) than those who did not yet have a TT. In patients with an endotracheal tube, none were able to talk or have oral intake, and the majority (99%) did not participate in out-of-bed exercises/active rehabilitation. After tracheostomy, patients subsequently received significantly less analgesic and sedative drugs and more antipsychotics. No clear differences in ICU and long-term mortality were associated with tracheostomy timing. Conclusions: Earlier tracheostomy is associated with earlier achievement of patient-centric outcomes – patients returning to usual daily activities such as talking, out-of-bed mobility, and eating/drinking significantly earlier, whilst also receiving less sedatives and analgesics.

Journal Title

Australian Critical Care

Conference Title
Book Title
Edition
Volume
Issue
Thesis Type
Degree Program
School
Publisher link
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement

© 2020 Australian College of Critical Care Nurses Ltd. Published by Elsevier Australia. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.

Item Access Status
Note

This publication was entered as an advanced online version.

Access the data
Related item(s)
Subject

Clinical sciences

Nursing

Persistent link to this record
Citation

Sutt, AL; Tronstad, O; Barnett, AG; Kitchenman, S; Fraser, JF, Earlier tracheostomy is associated with an earlier return to walking, talking, and eating, Australian Critical Care, 2020

Collections