Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan.

Publisher: Blackwell Publishing Country of Publication: England NLM ID: 101315570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1752-699X (Electronic) Linking ISSN: 17526981 NLM ISO Abbreviation: Clin Respir J Subsets: MEDLINE

Original Publication: Oxford : Blackwell Publishing

Respiration, Artificial*; Critical Illness/*therapy ; Tracheostomy/*adverse effects ; Ventilator Weaning/*methods; Aged, 80 and over ; Critical Illness/mortality ; Female ; Follow-Up Studies ; Hospital Mortality/trends ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Taiwan/epidemiology ; Time Factors

Introduction: Determining the optimal time for performing a tracheostomy and weaning a patient off a ventilator is typically challenging for physicians, respiratory therapists, patients and patients' families.
Purpose: This study examined the factors influencing tracheostomy timing and ventilator weaning and described the transition-care placement of patients who experience unsuccessful ventilator weaning.
Methods: A retrospective design was employed, and 2 years of data were collected through a medical chart review performed at a hospital in Northern Taiwan. Sixty patients who received tracheostomies in the intensive care unit (ICU) or respiratory care center were enrolled. The data included each patient's demographic information, disease diagnosis, and Glasgow Coma Scale score and Acute Physiology and Chronic Health Evaluation II scores.
Results: For patients on a ventilator in an ICU, the tracheostomy rate was 2.7%. Early (within 21 days) and late (>21 days) tracheostomies accounted for 36.7% and 63.3%, respectively. Of the patients who had received tracheostomies, 36.7% experienced ventilator weaning. The factors related to tracheostomy timing were disease diagnosis (P = 0.036) and days of ventilator use (P = 0.003). The factors related to ventilator weaning included disease diagnosis (P = 0.010) and tracheostomy timing (P = 0.001). Early tracheostomies were 10.9 times more likely than late tracheostomies to result in ventilator weaning (95%CI =2.5-47.7, P = 0.002).
Conclusions: Tracheostomy timing was strongly correlated with ventilator weaning. Early tracheostomy was higher successful ventilator weaning rates. The surgical patients were more likely to receive an early tracheostomy. However, the number of patients in Taiwan who received tracheostomies was lower than that in other countries. Further study maybe need to understand cultural variations in the acceptance of tracheostomies by patients.
(© 2016 John Wiley & Sons Ltd.)

Keywords: respiratory care; timing; tracheostomy; ventilator weaning

Date Created: 20160511 Date Completed: 20180822 Latest Revision: 20200808

20240829

10.1111/crj.12492

27162059