• Medicina intensiva · Nov 2012

    The indication of tracheotomy conditions the predictors of time to decannulation in critical patients.

    • G Hernández, R Ortiz, A Pedrosa, R Cuena, C Vaquero Collado, P González Arenas, S García Plaza, A Canabal Berlanga, and R Fernández.
    • Servicio de Cuidados Intensivos, Hospital Infanta Sofía, Madrid, Spain. ghernandezm@telefonica.net
    • Med Intensiva. 2012 Nov 1;36(8):531-9.

    ObjectiveVariables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation.DesignA prospective, observational cohort study was carried out.LocationTwo medical-surgical ICUs.PatientsWe included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2).InterventionsPatients were weaned and decannulated according to established protocols.Main VariablesWe recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included Cox-proportional multivariate analysis with time to decannulation as the dependent variable.ResultsA total of 227 patients were tracheostomized in the ICUs; of these, 151 were finally included in the study. In the multivariate analysis, time to decannulation in Group 1 was associated with the male gender (HR 1.74 (1.04-2.89), p= 0.03), age>60 years (HR 0.58 (0.36-0.91), p= 0.02), high suctioning frequency (HR 0.81 (0.67-0.97), p= 0.02), low forced vital capacity (HR 0.48 (0.28-0.82), p<0.01), and low peak flow (HR 0.25 (0.14-0.46), p<0.01). In Group 2 time to decannulation was associated to GCS >13 (HR 2.73 (1.51-4.91), p<0.01), high suctioning frequency (HR 0.7 (0.54-0.91), p<0.01), and inadequate swallowing (HR 1.97 (1.11-3.52), p=0.02).ConclusionVariables associated with longer time to decannulation in ICU-tracheostomized patients differ with the indications for tracheostomy.Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

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