Tracheostomy Outcomes in Muslim Intensive Care Unit Patients with Acute Respiratory Failure: Highlighting a Critical Palliative Care Gap.

Background: Tracheostomy often marks the onset of prolonged critical illness with high mortality, yet outcome data from Muslim-majority settings are unavailable. Methods: We conducted a retrospective cohort study (2019-2023) of Muslim intensive care unit (ICU) patients undergoing tracheostomy for acute respiratory failure. The primary outcome was in-hospital mortality; secondary outcomes included ICU mortality, code-status transitions, and one-year survival. Results: Among 411 patients (median age 68 years; 55% male), 68% were hospice-eligible at admission, while 38% were bedridden. In-hospital mortality was 53%; one-year mortality, 68%. Although 90% were full code pre-tracheostomy, 77% transitioned to Do Not Attempt Resuscitation afterward. Palliative care consultation occurred in only 12%. Key mortality predictors included age, comorbidity burden, bedridden status, and receipt of cardiopulmonary resuscitation. Conclusions: This study highlights three critical gaps in Muslim patients undergoing tracheostomy: high mortality, delayed code transitions, and inadequate palliative care before and during hospitalization. Future research should focus on strategies to bridge these palliative gaps.