Tracheostomy in patients with acute respiratory distress syndrome is not related to quality of life, symptoms of psychiatric disorders or return-to-work: the prospective DACAPO cohort study
Authors: Blecha Sebastian , Brandl Magdalena , Zeman Florian , Dodoo-Schittko Frank , Brandstetter Susanne , Karagiannidis Christian , Bein Thomas , Apfelbacher Christian ,   for the DACAPO Study Group, Bickenbach Johannes , Beeker Thorben , Schürholz Tobias , Pezechk Jessica , Schloer Jens , Jaschinski Ulrich , Kummer Ilse , Kuckein Oliver , Weber-Carstens Steffen , Goldmann Anton , Angermair Stefan , Stoycheva Krista , Brederlau Jörg , Rieckehr Nadja , Schreiber Gabriele , Haennicke Henriette , Bach Friedhelm , Gummelt Immo , Haas Silke , Middeke Catharina , Vedder Ina , Klaproth Marion , Adamzik Michael , Karlik Jan , Martini Stefan , Robitzky Luisa , Putensen Christian , Muders Thomas , Lohmer Ute , Dembinski Rolf , Schäffner Petra , Wulff-Werner Petra , Landsiedel-Mechenbier Elke , Nickoleit-Bitzenberger Daniela , Silber Ann-Kathrin , Ragaller Maximilian , de Abreu Marcello Gama , Ulbricht Alin , Reisbach Linda , Zacharowski Kai , Meybohm Patrick , Hötzel Alexander , Kalbhenn Johannes , Metz Christoph , Haschka Stefan , Rauch Stefan , Quintel Michael , Harnisch Lars-Olav , Baumann Sophie , Kernchen Andrea , Friesecke Sigrun , Maletzki Sebastian , Kluge Stefan , Boenisch Olaf , Frings Daniel , Füllekrug Birgit , Jahn Nils , Kampe Knut , Ringeis Grit , Singer Brigitte , Wüstenberg Robin , Ahrens Jörg , Ruschulte Heiner , Gerdes Andre , Groß Matthias , Wiesner Olaf , Bayat-Graw Aleksandra , Brenner Thorsten , Schmitt Felix , Lipinski Anna , Henzler Dietrich , Eickmeyer Klaas , Krebs Juliane , Rodenberg Iris , Groesdonk Heinrich , Meiers Kathrin , Salm Karen , Volk Thomas , Fischer Stefan , Redwan Basam , Schmölz Martin , Schumann-Stoiber Kathrin , Eberl Simone , Lenz Gunther , von Wernitz-Keibel Thomas , Zackel Monika , Bloos Frank , Bloos Petra , Braune Anke , Haucke Anja , Noack Almut , Kolanos Steffi , Kuhnsch Heike , Knuhr-Kohlberg Karina , Gehling Markus , Haller Mathias , Sturm Anne , Rossenbach Jannik , Schädler Dirk , D’Aria Stefanie , Karagiannidis Christian , Straßmann Stephan , Windisch Wolfram , Annecke Thorsten , Herff Holger , Schütz Michael , Bercker Sven , Reising Hannah , Dathe Mandy , Schlegel Christian , Lichy Katrin , Zink Wolfgang , Kötteritzsch Jana , Bodenstein Marc , Mauff Susanne , Straub Peter , Strang Christof , Prätsch Florian , Hachenberg Thomas , Kirschning Thomas , Friedrich Thomas , Mangold Dennis , Arndt Christian , Koch Tilo , Haake Hendrik , Offermanns Katrin , Friederich Patrick , Bingold Florian , Irlbeck Michael , Zwissler Bernhard , Kaufmann Ines , Bogdanski Ralph , Kapfer Barbara , Heim Markus , Edenharter Günther , Ellger Björn , Bause Daniela , Gerresheim Götz , Muschner Dorothea , Christ Michael , Geise Arnim , Beiderlinden Martin , Heuter Thorsten , Wipfel Alexander , Kargl Werner , Harth Marion , Englmeier Christian , Bein Thomas , Blecha Sebastian , Thomann-Hackner Kathrin , Zeder Marius , Stephan Markus , Glaser Martin , Häberle Helene , Bracht Hendrik , Heer Christian , Mast Theresa , Kredel Markus , Müllenbach Ralf , Sebök Phillip , Thomann-Hackner Kathrin , Loss Julika , Graf Bernhard , Leitzmann Michael , Pfeifer Michael , Bein Simon , Brunnthaler Vreni , Forster Carina , Hertling Stefanie , Höhne Sophie , Schimmele Carolin , Valletta Elisa 
Published: May 2020

Abstract
Background
Acute respiratory distress syndrome (ARDS) is a life-threatening condition that often requires prolonged mechanical ventilation. Tracheostomy is a common procedure with some risks, on the other hand with potential advantages over orotracheal intubation in critically ill patients. This study investigated the association of tracheostomy with health-related quality of life (HRQoL), symptoms of psychiatric disorders and return-to-work of ARDS survivors.

Methods
Data were collected in the context of the prospective observational German-wide DACAPO study. Clinical and demographic patient data and treatment characteristics were obtained from the participating intensive care units (ICU). HRQoL and return-to-work were assessed using patient-reported questionnaires 3, 6 and 12 months after ICU discharge. HRQoL was measured with the Physical and Mental Component Scale of the Short-Form 12 Questionnaire (PCS-12, MCS-12). The prevalence of psychiatric symptoms (depression and post-traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire-9 and the Post-Traumatic Stress Syndrome-14. Physician-diagnosed anxiety and obsessive–compulsive disorder were recorded by patient self-report in the follow-up questionnaires. The associations of tracheostomy with HRQoL, psychiatric symptoms and return-to-work after 12 months were investigated by means of multivariable linear and logistic regression models.

Results
Primary 877 ARDS patients (mean ± standard deviation: 54 ± 16 years, 68% male) survived and were discharged from ICU. Out of these patients, 478 (54.5%) were tracheotomised during ICU treatment. After 12 months, patient-reported outcomes could be analysed of 388 (44.2%) respondents, 205 with tracheostomy and 183 without. One year after ICU discharge, tracheostomy showed no significant association with physical or mental health-related quality of life (PCS-12: − 0.73 [− 3.96, 2.51]; MCS-12: − 0.71 [− 4.92, 3.49]), symptoms of psychiatric disorders (depression: 0.10 [− 1.43, 1.64]; PTSD: 3.31 [− 1.81, 8.43]; anxiety: 1.26 [0.41, 3.86]; obsessive–compulsive disorder: 0.59 [0.05, 6.68]) or return-to-work (0.71 [0.31, 1.64]) in the multivariable analysis (OR [95%-CI]).

Conclusions
Up to 1 year after ICU discharge, neither HRQoL nor symptoms of psychiatric disorders nor return-to-work was affected by tracheostomy.
Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered)