Decannulation of critically ill patients after long-term mechanical ventilation – predictors from clinical routine data

摘要

Introduction: Variables predicting successful decannulation from a tracheotomy tube after long-term mechanical ventilation remain obscure. Material and methods: To identify such predictors, data from 150 consecutive critically ill patients with a tracheotomy for the purpose of mechanical ventilation were analyzed retrospectively. Of the 150 tracheotomized patients who were admitted to a rehabilitation center, 103 were successfully decannulated. Items concerning socio-demographic data, indication for mechanical ventilation (neurologic, cardiologic, respiratory or gastro-intestinal disease), comorbidities, tracheotomy technique (dilatational vs. surgical), duration of mechanical ventilation, complications during weaning from tracheotomy tube, and also care dependency, alertness and the degree of aspiration at admission to the rehabilitation clinic were tested using a multiple logistic regression model.Results: A successful decannulation was associated with no complications during decannulation procedure (OR 0.175, 95% CI; p=0.002), high alertness at the beginning of rehabilitation (OR 1.079, 95% CI; p=0.014), female gender (OR 0.338, 95% CI; p=0.031), a low number of comorbidities (OR 0.737, 95% CI; p=0.043), and dilatational tracheotomy (OR 2.375, 95% CI; p=0.054). Conclusions: The identified predictor variables can be collected easily in the clinical routine. Except for complications during decannulation procedure all predictors can be assessed at admission with the result that a prediction of decannulation success is possible very early in clinical course.