Canadian Health: Patients with tracheostomy for respiratory failure
Our 30% 6-month mortality was similar to the 33% found by Seneff et al in chronically ventilated patients being considered for transfer to a specialized weaning center. Similar 6-month mortality rates of 25% and 22% were found in patients receiving at least 5 days or at least 7 days, respectively, of mechanical ventilation. After this initial high 6-month mortality, mortality curves tended to flatten out. 
At follow-up, we found that most responders had good emotional health but remained with major physical limitations. This is similar to Chatila et who evaluated survivors of a ventilator rehabilitation unit. They found mild to moderate impairment in quality of life as measured by the sickness impact profile in most patients. Subjects with chronic diseases did worse.
There are several limitations to this study. The study was conducted at only one hospital and may not be representative of other patient populations. In particular, we had a high proportion of trauma and head injury patients, reflecting level I trauma status. Although timing of tracheostomy and choice of patients receiving tracheostomy may differ from center to center and physician to physician, we chose to study tracheostomy patients rather than a defined number of days of mechanical ventilation because the performance of a tracheostomy is a natural decision point for patients and their families to decide on the amount of care to continue to provide. In the United States, tracheostomy also moves the patient into a particular DRG with an increased reimbursement. However, this limits its comparison with other studies that used a defined number of days, such as 4, 7, or 10, to define respiratory failure. Another limitation is the low level of patient participation (39%) in completing the SF-36. This may have limited the ability to detect clinically important differences between groups. Many patients died before the study was conducted. They tended to be sicker and more likely to require ventilator or airway support at hospital discharge. If studied before they died, they may have had even lower scores on the SF-36. However, among survivors, there were only minor differences in demographics, comorbidities, and hospital course between participants, those who refused, and those unable to be contacted.
In summary, we found that overall survival and functional status are poor in patients with tracheostomy for respiratory failure. Patients who are liberated from mechanical ventilation and have their tracheostomy tubes removed have a much better survival; however, it comes at a higher hospital cost and longer length of stay.
