Evaluation of the Clinical Course in Patients Discharged with Tracheostomy

Objective:The objectives of this study are to determine the problems of patients who underwent percutaneous tracheostomy opening in intensive care and then were discharged with a tracheostomy that had either spontaneous respiration or mechanical ventilation (MV) support, and decrease the morbidity and mortality of these patients by focusing on training their caregivers about potential problems.Materials and Methods:The files of 90 patients, who were admitted to the intensive care unit (ICU) between 2017 and 2018 with a tracheostomy, were analysed. Twenty-nine patients were discharged. Patients were grouped as cerebrovascular disease (CVD), respiratory failure (RF), neuromuscular diseases and others (Alzheimer’s, Parkinson’s). Patients and their caregivers were interviewed face-to-face or by telephone to obtain information about patients. The reasons for hospitalisation, Glasgow coma scale (GCS) score, feeding patterns, MV support, life expectancy and problems at home were recorded.Results:In 29 discharged patients, 14 of them were classified as CVD, five as RF, six as neuromuscular disease (NMD) and four as other. The mortality rates of patients with high GCS values (GCS-2) from ICU were found to be lower. The fatality rate for the NMD group (0%) was found to be significantly lower than that of CVD (64.3%) and RF (80%). Seven (50%) patients developed contracture or limited joint motion. Respiratory-related problems were the most common problems that patients experienced at home, and 12 (85.7%) had intense secretions. Constipation was the most common nutritional problem and was experienced by six patients (42.9%).Conclusion:The home care of patients with a tracheostomy requires specific procedures and may lead to the development of specific complications. In this study, we determined that the respiratory problems of home care patients, particularly those involving intense secretions, plugged the tracheostomy and required the need for MV. Another important problem is that patients have limited joint motion. Thus, before discharge, patients should be trained consistently.