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The effect of tracheostomy delay time on outcome of patients with prolonged mechanical ventilation: A STROBE-compliant retrospective cohort study.
Abstract
The tracheostomy timing for patients with prolonged mechanical ventilation (PMV) was
usually delayed in our country. Both physician decision time and tracheostomy delay
time (time from physician's suggestion of tracheostomy to procedure day) affect tracheostomy
timing. The effect of tracheostomy delay time on outcome has not yet been evaluated
before.Patients older than 18 years who underwent tracheostomy for PMV were retrospectively
collected. The outcomes between different timing of tracheostomy (early: ≤14 days;
late: >14 days of intubation) were compared. We also analyzed the effect of physician
decision time, tracheostomy delay time, and procedure type on clinical outcomes.A
total of 134 patients were included. There were 57 subjects in the early tracheostomy
group and 77 in the late group. The early group had significantly shorter mechanical
ventilation duration, shorter intensive care unit stays, and shorter hospital stays
than late group. There was no difference in weaning rate, ventilator-associated pneumonia,
and in-hospital mortality. The physician decision time (8.1 ± 3.4 vs 18.2 ± 8.1 days,
P < .001) and tracheostomy delay time (2.1 ± 1.9 vs 6.1 ± 6.8 days, P < .001) were
shorter in the early group than in the late group. The tracheostomy delay time [odds
ratio (OR) = 0.908, 95% confidence interval (CI) = 0.832-0.991, P = .031) and procedure
type (percutaneous dilatation, OR = 2.489, 95% CI = 1.057-5.864, P = .037) affected
successful weaning. Platelet count of >150 × 10/μL (OR = 0.217, 95% CI = 0.051-0.933,
P = .043) and procedure type (percutaneous dilatation, OR = 0.252, 95% CI = 0.069-0.912,
P = .036) were associated with in-hospital mortality.Shorter tracheostomy delay time
is associated with higher weaning success. Percutaneous dilatation tracheostomy is
associated with both higher weaning success and lower in-hospital mortality.
Type
Journal articleSubject
HumansRespiration, Artificial
Length of Stay
Ventilator Weaning
Tracheostomy
APACHE
Hospital Mortality
Odds Ratio
Retrospective Studies
Comorbidity
Time Factors
Aged
Aged, 80 and over
Middle Aged
Intensive Care Units
Taiwan
Female
Male
Pneumonia, Ventilator-Associated
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https://hdl.handle.net/10161/22244Published Version (Please cite this version)
10.1097/md.0000000000016939Publication Info
Tai, Hsueh-Ping; Lee, David Lin; Chen, Chiu-Fan; & Huang, Yuh-Chin Tony (2019). The effect of tracheostomy delay time on outcome of patients with prolonged mechanical
ventilation: A STROBE-compliant retrospective cohort study. Medicine, 98(35). pp. e16939. 10.1097/md.0000000000016939. Retrieved from https://hdl.handle.net/10161/22244.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Yuh-Chin Tony Huang
Professor of Medicine
Closed loop ventilation Environmental medicine Oxidative lung injuryCOPDHyperpolarized
129Xe MRI and regional lung function

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