Prediction of successful de-cannulation of tracheostomised patients in medical intensive care units

Chul Park,Ryoung-Eun Ko,Kyeongman Jeon,Soo Jin Na,Jinhee Jung

doi:10.1186/s12931-021-01732-w

Abstract

BackgroundLimited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies. We evaluated factors associated with failed de-cannulations to develop a prediction model that could be easily be used at the time of weaning from MV.MethodsIn a retrospective cohort of 346 tracheostomised patients managed by a standardized de-cannulation program, multivariable logistic regression analysis identified variables that were independently associated with failed de-cannulation. Based on the logistic regression analysis, the new predictive scoring system for successful de-cannulation, referred to as the DECAN score, was developed and then internally validated.ResultsThe model included age > 67 years, body mass index < 22 kg/m2, underlying malignancy, non-respiratory causes of mechanical ventilation (MV), presence of neurologic disease, vasopressor requirement, and presence of post-tracheostomy pneumonia, presence of delirium. The DECAN score was associated with good calibration (goodness-of-fit, 0.6477) and discrimination outcomes (area under the receiver operating characteristic curve 0.890, 95% CI 0.853–0.921). The optimal cut-off point for the DECAN score for the prediction of the successful de-cannulation was ≤ 5 points, and was associated with the specificities of 84.6% (95% CI 77.7–90.0) and sensitivities of 80.2% (95% CI 73.9–85.5).ConclusionsThe DECAN score for tracheostomised patients who are successfully weaned from prolonged MV can be computed at the time of weaning to assess the probability of de-cannulation based on readily available variables.

Highlights

Limited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies
Tracheostomy is a common procedure performed in intensive care unit (ICU) patients who require prolonged mechanical ventilation (MV) in cases associated with acute respiratory failure and other airway issues [1, 2]
To address the primary research objective associated with the determination of the factors related with failed de-cannulation, patients who expired in ICU (n = 479), whose life support treatments were withdrawn before weaning from MV (n = 54), who were transferred to other hospitals (n = 36), who were not weaned from MV (n = 25), accidental decannulation before weaning from MV (n = 11), and insufficient data on weaning from MV (n = 8) were excluded

Summary

Introduction

Limited data are available on practical predictors of successful de-cannulation among the patients who undergo tracheostomies. We evaluated factors associated with failed de-cannulations to develop a prediction model that could be be used at the time of weaning from MV. Tracheostomy is a common procedure performed in intensive care unit (ICU) patients who require prolonged mechanical ventilation (MV) in cases associated with acute respiratory failure and other airway issues [1, 2]. Park et al Respir Res (2021) 22:131 should be considered when possible complications associated with the tube placement have been resolved [6]. Old age, prolonged MV support, and muscle weakness have been reported as risk factors for de-cannulation failure [8, 9]. It is necessary to predict at the time of weaning from MV whether de-cannulation is possible or additional interventions is required for successful de-cannulation

Methods

Results

Conclusion