Variable Goal, Outcome Attainment for Tracheostomy Patients in LTACHs

Chronically critically ill geriatric patients admitted to a long-term acute care hospital (LTACH) with a tracheostomy showed variable goal attainment during recovery, according to a new Annals of the American Thoracic Society study.

Researchers sought to understand more about goals and functional outcome achievement of intensive care unit (ICU) survivors admitted to an LTACH with a tracheostomy. The study included 50 older adult patients with a median duration of intubation of 13 days prior to tracheostomy.

Patient assessments indicated that 80% of participants had ICU-acquired weakness and 72% had cognitive impairment at the beginning of the study, as measured by the Medical Research Council scale (MRC) and Montreal Cognitive Assessment, respectively Additionally, 16 patients (32%) experienced moderate to severe anxiety, 9 (18%) experienced moderate-to-severe depression, and 11 (22%) reported PTSD symptoms.

Goals included eating and drinking, speaking, walking, returning home, and toileting. By the time of discharge, 97% of patients who ranked speaking as a top goal could speak and 88% could eat and drink, but only 21% were walking and 18% were self-toileting.

“Discharge to the home or acute rehabilitation setting, achieved in 52% of the population, was associated with greater strength, as measured by the total MRC score (P=.002), as well as the EuroQOL domains of mobility (P=.008) and self-care (P=.04),” found the researchers.

The Researchers noted that variable findings indicate the importance of setting “realistic expectations informed by functional assessments” during chronically critically ill patient rehabilitation in an LTACH.

Reference:
Dubin R, Vieth JM, Grippi MA, et al. Functional outcomes, goals, and goal attainment amongst chronically critically ill long-term acute care hospital patients [published online ahead of print May 13, 2021]. Ann Am Thorac Soc. 2021;10.1513/AnnalsATS.202011-1412OC. doi:10.1513/AnnalsATS.202011-1412OC