Introduction
Materials and methods
Setting
Patients and RCC admission criteria
RCC description
Variables measured
Statistical analysis
Variable | Tracheostomy (n = 985) | Translaryngeal tube (n = 227) | P value |
---|---|---|---|
Age (years) † | 73.17 ± 15.04 | 73.56 ± 15.69 | 0.73 |
Male ‡ | 551 (55.94%) | 107 (47.14%) | 0.02* |
Transferred from MICU ‡ | 691 (70.15%) | 181 (79.74%) | < 0.01* |
APACHE II† | 18.58 ± 5.53 | 20.30 ± 5.86 | < 0.01* |
Reason for MV|| | < 0.01* | ||
Acute lung injury | 229 (23.25%) | 69 (30.40%) | |
Chronic lung disease | 207 (21.02%) | 37 (16.30%) | |
Postoperative | 86 (8.73%) | 21 (9.25%) | |
Cardiac disease | 145 (14.72%) | 33 (14.54%) | |
Neuronal | 242 (24.57%) | 37 (16.30%) | |
Miscellaneous | 76 (7.72%) | 30 (13.22%) | |
ICU MV (days)§ | 28 (0, 213) | 27 (1, 123) | < 0.01* |
Bedridden before admission‡ | 194 (19.70%) | 52 (22.91%) | 0.29 |
Sum of chronic comorbidities§ | 1 (0, 5) | 1 (0, 4) | 0.75 |
Sum of chronic comorbidities|| | 0.52 | ||
0 | 183 (18.58) | 36 (15.86) | |
1 | 404 (41.02) | 104 (45.81) | |
2 | 271 (27.51) | 66 (29.07) | |
3 | 111 (11.27) | 18 (7.93) | |
4 | 13 (1.32) | 3 (1.32) | |
5 | 3 (0.30) | 0 | |
Required hemodialysis‡ | 157 (15.94%) | 30 (13.22%) | 0.31 |
Modified GCS† | 8.91 ± 2.63 | 8.48 ± 2.94 | 0.04* |
RSBI§ | 128 (7, 818) | 122 (11, 550) | 0.49 |
PImax§ | 27 (1, 75) | 29 (8, 75) | 0.02* |
PaO2/FIO2§ | 251.5 (61, 700) | 290 (105, 577) | < 0.01* |
Albumin (g/dl)† | 2.69 ± 0.49 | 2.64 ± 0.50 | 0.16 |
BUN (mg/dl)§ | 29 (3.3, 234) | 30.5 (4.9, 296) | 0.04* |
Results
Variable | Tracheostomy (n = 985) | Translaryngeal tube (n = 227) |
P value
|
---|---|---|---|
Length of stay (days)§ | 82 (12, 806) | 64 (1, 424) | < 0.01* |
RCC length of stay (days)§ | 22 (0, 151) | 14 (0, 151) | < 0.01* |
Total MV days§ | 53 (8, 246) | 41 (0, 216) | < 0.01* |
Weaned† | 549 (55.74%) | 136 (59.91%) | 0.25 |
In-hospital mortality† | 303 (30.76%) | 102 (44.93%) | < 0.01* |
RCC mortality† | 210 (69.31%) | 69 (67.65%) | 0.75 |
Successful weaning | Survival | |||
---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | |
APACHE II <18 | 0.61 (0.48-0.79) | < 0.01* | 0.61 (0.47-0.79) | < 0.01* |
Albumin >2.5 g/dL | 1.54 (1.22-1.95) | < 0.01* | 1.80 (1.40-2.31) | < 0.01* |
BUN <40 mg/dL | 0.54 (0.42-0.70) | < 0.01* | 0.45 (0.34-0.59) | < 0.01* |
Performing tracheostomy | 1.34 (0.99-1.82) | 0.06 | 1.72 (1.26-2.34) | < 0.01* |
Tracheostomy (n = 129) | Translaryngeal tube (n = 129) |
P value
| |
---|---|---|---|
Age (years)† | 71.77 ± 17.30 | 74.43 ± 13.44 | 0.13 |
Male‡ | 62 (48.06%) | 64 (49.61%) | 0.80 |
Transfer from MICU‡ | 88 (68.22%) | 94 (72.87%) | 0.45 |
APACHE II† | 20.02 ± 6.10 | 20.35 ± 5.50 | 0.58 |
Reason of MV‡ | 0.75 | ||
Acute lung injury | 30(23.26) | 28(21.71) | |
Chronic lung disease | 23(17.83) | 18(13.95) | |
Post op | 11(8.53) | 19(14.73) | |
Cardiac disease | 20(15.50) | 23(17.83) | |
Neuron | 33(25.58) | 23(17.83) | |
Miscellaneous | 12(9.30) | 18(13.95) | |
ICU MV (days)† | 28 (9, 87) | 27 (15, 65) | 0.33 |
Bed ridden prior to admission‡ | 22 (17.05%) | 29 (22.48%) | 0.27 |
Sum of chronic comorbidities‡ | 0.70 | ||
0 | 31 (24.03) | 27 (20.93) | |
1 | 45 (34.88) | 55 (42.64) | |
2 | 37 (28.68) | 37 (28.68) | |
3 | 16 (12.40) | 8 (6.20) | |
4 | 0 | 2 (1.55) | |
5 | 31 (24.03) | 27 (20.93) | |
Required hemodialysis‡ | 31 (24.03%) | 19 (14.73%) | 0.03* |
Modified GCS† | 8.67 ± 2.74 | 8.47 ± 2.96 | 0.52 |
RSBI† | 148 (17, 418) | 122 (11, 550) | 0.36 |
PImax† | 30 (1, 74) | 29 (8, 75) | 0.91 |
PaO2/FiO2† | 289 (91, 700) | 291 (112, 577) | 0.35 |
Albumin (g/dL)† | 2.80 ± 0.50 | 2.69 ± 0.42 | 0.06 |
BUN (mg/dL)† | 31 (6, 215) | 30 (4.9, 220) | 0.95 |
Length of stay (days)§ | 84 (32, 806) | 72 (19, 197) | 0.04* |
RCC length of stay (days)§ | 28 (5, 121) | 16 (2, 151) | < 0.01* |
Total MV days§ | 55 (21, 173) | 44 (19, 186) | < 0.01* |
Weaned|| | 84 (65.12%) | 82 (63.57%) | 0.79 |
In-hospital mortality|| | 19 (14.73%) | 50 (38.76%) | 0.08 |
RCC mortality|| | 12 (63.16%) | 32 (64.00%) | 0.72 |
Discussion
Conclusions
Key messages
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The type of prolonged mechanical ventilation does not appear to be an important determinant of successful weaning in a specialized respiratory care center.
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The subgroup of patients who fared best after mechanical ventilation had lower BUN levels, higher albumin concentrations, moderate APACHE II scores, and had tracheostomies.
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The significant association between tracheostomy and patient survival suggests that tracheostomy may be the optimal method of mechanical ventilation.