• Vinciya Pandian, Mohit Datta, Sajan Nakka, Devi S Tammineedi, Patricia M Davidson, and Paul A Nyquist.
• Vinciya Pandian is an assistant professor in the Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland, and in the Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland. Mohit Datta is an assistant professor in the Department of Surgery, Palmetto Health USC, University of South Carolina, Columbia, South Carolina. Sajan Nakka is research assistant and Patricia M. Davidson is a dean and professor in the Department of Acute and Chronic Care, Johns Hopkins School of Nursing. Devi S. Tammineedi is a research assistant in the Department of Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine. Paul A. Nyquist is an associate professor in the departments of neurology, anesthesia/critical care medicine, neurosurgery, and general internal medicine, Johns Hopkins School of Medicine. vpandia1@jhu.edu.
• Am. J. Crit. Care. 2019 Jan 1; 28 (1): 56-63.

BackgroundReadmission for ventilator support in tracheostomy patients with primary brain injury is often attributed to failure of airway protection and aspiration pneumonia. Data regarding the incidence of intensive care unit readmissions and associated factors in these patients are limited.ObjectivesTo determine the factors associated with intensive care unit readmission among tracheostomy patients with primary brain injury, as compared with tracheostomy patients without primary brain injury.MethodsProspectively acquired data from an ongoing tracheostomy registry at an academic health center were reviewed retrospectively. A total of 164 patients more than 18 years of age who received an elective tracheostomy and had at least 1 readmission to the intensive care unit between 2007 and 2013 were included.ResultsThe incidence of mechanical ventilation resumption and readmission was significantly higher in patients with than without primary brain injury (P = .005). Patients requiring tracheostomy for airway protection were at a higher risk for atelectasis (odds ratio, 8.23; P = .05). In patients with primary brain injury, a higher Glasgow Coma Scale score was associated with a lower risk for atelectasis (odds ratio, 0.84; P = .04). Mean (SD) Glasgow Coma Scale score was higher in patients without primary brain injury (10.64 [3.98]) than in patients with primary brain injury (8.62 [4.57]; P = .006).ConclusionsTracheostomy patients with primary brain injury may have central nervous system-mediated respiratory compromise associated with reduced Glasgow Coma Scale score, increased atelectasis, and shorter duration of ventilator dependency.©2019 American Association of Critical-Care Nurses.

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