Comparison of outcomes in patients tracheostomized at different fio2 settings

SESSION TITLE: Critical Care Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Current guidelines for the readiness for Spontaneous Breathing Trials (SBT) and the ability to be weaned off a ventilator includes oxygen saturation (SaO2)≥89% on fraction of inspired oxygen (FiO2)≤40%. Our study compared outcomes of patients who underwent a tracheostomy at different FiO2 settings with the aim to facilitate optimal settings for a tracheostomy. METHODS: We performed a retrospective observational cohort study of 604 consecutive tracheostomized patients hospitalized in an intensive care unit (ICU) within the Mount Sinai Health System between March 2020 to September 2021. We analyzed clinical characteristics and outcomes of patients who underwent a tracheostomy at FiO2 settings of ≥50% or <50%. RESULTS: 221 patients were tracheostomized at FiO2≥50% and 383 patients were tracheostomized at FiO2<50%. Both groups had a similar mean age (61.94 and 61.83 years), gender proportion (37.9% vs 32.6% females), and co-morbidities. At the time of tracheostomy, lower pH (7.41 vs 7.44, p<0.001), higher pCO2 (44.6 vs 38.3, p<0.001), and higher positive end-expiratory pressure (PEEP) (7.41 vs 5.48, p<0.001) were observed in the FiO2≥50% group. Longer time from tracheostomy to first pressure support (3.03 days vs 1.67 days, p<0.001) and tracheostomy collar trials (9.37 days vs 5.11 days, p<0.001) were seen in the FiO2≥50% group, but no difference were observed between time to speech valve placement and decannulation. There was no statistical difference in tracheostomy-associated complications between the two groups. Higher in-hospital mortality was seen in FiO2≥50% group (46.6% vs 30.3%, p<0.001), but one-year mortality was similar between the two groups (29.9% vs 33.4%, p=0.417). More patients were discharged home from FiO2<50% group, compared to larger proportion of discharges to a long-term acute care hospital (LTACH) in the FiO2≥50% group. CONCLUSIONS: Despite tracheostomies being performed at higher ventilator settings than current guidelines, there was no observed difference in complication rates in the group tracheostomized at higher FiO2 settings compared to lower FiO2 settings. Patients tracheostomized at higher FiO2 settings demonstrated longer time to pressure support or tracheostomy collar trial and higher in-hospital mortality but had similar long-term outcomes of time to speech valve placement, decannulation, and lower one-year mortality. CLINICAL IMPLICATIONS: Physicians should evaluate suitability for tracheostomy even in patients who are requiring higher ventilator settings with the aim to provide better opportunities of long-term recovery. DISCLOSURES: No relevant relationships by Jeeyune Bahk No relevant relationships by Bridget Dolan No relevant relationships by Jennifer Fung No relevant relationships by Young Lee No relevant relationships by Mantej Sehmbhi No relevant relationships by Venus Sharma