Model identifies ICU candidates for early tracheostomy
medwireNews: A four-item model could help select patients in the intensive care unit (ICU) who would benefit from early tracheostomy, Chilean researchers report.
The model is simple to apply and has a good discriminatory capacity but needs to be validated before it can be brought into wider use, says the team behind the research.
Prolonged invasive mechanical ventilation carries a risk for serious complications, hence there is interest in performing early tracheostomy in suitable patients.
In this study, Felipe Martinez (Universidad de Valparaíso) and colleagues looked for predictors of outcomes in a cohort of 349 patients admitted to an ICU unit over a year.
In all, 142 patients (40.7%) required invasive mechanical ventilation during their hospital stay and were included in the analysis. There was a preponderance of men (60.5%), the mean age was 65.8 years, and the median Charlson Comorbidity Index was 2 points, indicating a moderate comorbidity burden.
A total of 34 patients required ventilator support for 7 or more days, 16 (11.5%) of whom received a tracheostomy.
In a multivariate logistic regression model, four factors were significant predictors for needing prolonged intubation. These were the patient's age (adjusted odds ratio[OR]=2.0 per increasing tertile); the presence of hypernatremia on intubation (OR=3.9); chronic pulmonary disease (OR=3.0); and a PaO2/FiO2 ratio of less than 200 (OR=2.6).
When combined, these four factors showed a good ability to discriminate patients who needed prolonged intubation from those who did not, with an area under the receiver operating characteristic curve of 0.81.
Writing in the American Journal of Otolaryngology, Martinez and colleagues note that all four factors identified in the model "have clear biologic plausibility." They say that future work could address whether lactate levels correlate with the duration of ventilation, as this is "a reliable and frequently used biomarker of clinical perfusion."
They conclude: "Although the overall diagnostic capacity of the multivariate model was good, it is necessary to conduct formal validation before recommending its use in clinical decision making."
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By Joanna Lyford