Long-term survival in patients with tracheostomy and prolonged mechanical ventilation in Olmsted County, Minnesota.

BACKGROUND An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective. METHODS We retrospectively reviewed the electronic medical records of adult Olmsted county, Minnesota, residents admitted to the intensive care units at the 2 Mayo Clinic Rochester hospitals from January 1, 2003, to December 31, 2007, who underwent tracheostomy for PMV. RESULTS Sixty-five patients, median age 68 years (interquartile range [IQR] 49-80 y), 39 male, underwent tracheostomy for PMV, resulting in an age-adjusted incidence of 13 (95% CI 10-17) per 100,000 patient-years at risk. The median number of days on mechanical ventilation was 24 days (IQR 18-37 d). Forty-six patients (71%) survived to hospital discharge, and 36 (55%) were alive at 1-year follow-up. After adjusting for age and baseline severity of illness, the presence of COPD was independently associated with 1-year mortality (hazard ratio 3.4, 95% CI 1.4-8.2%). CONCLUSIONS There was a considerable incidence of tracheostomy for PMV. The presence of COPD was an independent predictor of 1-year mortality.