Outcomes of Introducing Shared Decision-Making for Tracheostomy on Prolonged Intubated Critical Patients.

Abstract

Aim: Tracheostomy has been relatively unpopular in Taiwan. Here, we investigate the impact of shared decision-making (SDM) for tracheostomy on critical patients undergoing prolonged intubation.

Methods: We retrospectively enrolled 1464 patients admitted to a tertiary medical centre intensive care unit (ICU) due to respiratory failure between April 2017 and April 2023. A 2-to-1 propensity- score with nearest-neighbour matching was used to balance covariates across SDM and non-SDM groups. Outcomes, including tracheostomy rate, intubation to tracheostomy time, mortality rate, ventilator weaning rate, ICU admission days, length of hospital stay, and 6-month post-discharge readmission rate were collected. Binary outcomes (Tracheostomy rate, in-hospital mortality, and 6-month readmission rate) were analysed using multivariable logistic regression, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Continuous outcomes (Intubation to Tr. T, ICU days, and length of stay) were assessed with generalised linear models, reported as regression coefficients (β) with 95% CIs.

Results: We found that SDM introduction was associated with a higher tracheostomy (44.3% vs. 30.9%, p<0.001) and lower in-hospital mortality rates (15.7% vs. 26.5%, p=0.004), but failed to demonstrate significant impacts on the intubation-to-tracheostomy time (25.8±16.8 vs. 28.8±17.6 d, p = 0.05) and the rest of the clinical outcomes. Subgroup analysis showed SDM had the greatest benefit to those with prior respiratory, neuromuscular, and malignant diseases.

Conclusion: Introducing SDM for prospective tracheostomy recipients is associated with better clinical outcomes in critical patients undergoing prolonged intubation.