Objective

To assess variables associated with decannulation in patients with traumatic brain injury (TBI).

Participants

79 patients with TBI requiring tracheostomy and ICU admission from January 1^st to December 31^st, 2014.

Design

Retrospective analysis.

Measures

Patients decannulated prior to 90 days were compared with patients who remained cannulated. Two Cox Proportional Hazards models were used to predict decannulation using variables prior to tracheostomy and throughout hospitalization.

Results

Median time to decannulation was 37 days (Interquartile Range [IQR] 29–67). Variables prior to tracheostomy associated with decannulation included diabetes (HR, 0.15; 95% CI, 0.03–0.84; p =.03), craniotomy (HR, 0.25; 95% CI, 0.06–1.02; p =.05) and acute kidney injury (AKI) (HR, 0.06; 95% CI, 0.01–0.48; p =.01). Variables present throughout hospitalization included age (HR, 1.12; 95% CI, 1.01–1.21; p =.03), ventilator days (HR, 0.74; 95% CI, 0.57–0.95; p =.02), reintubation (HR, 0.07; 95% CI, 0.01–0.64; p =.02), aspiration (HR, 0.01; 95% CI, 0.0–0.29, p =.01), craniotomy (HR, 0.004; 95% CI, 0.0–0.39; p =.02) and AKI (HR, 0.0; 95% CI, 0.0–0.21; p =.01).

Conclusion

The presence of diabetes, craniotomy and acute kidney injury may inform the conversation surrounding chances for decannulation prior to tracheostomy.

中文翻译：

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严重外伤性脑损伤患者气管切开术脱管的相关因素。

目的

评估与颅脑外伤（TBI）患者的脱皮术相关的变量。

参加者

2014年1月1^日至12月31^日，有79例TBI患者需要气管切开术和ICU入院。

设计

回顾性分析。

措施

将90天前未拔管的患者与仍插管的患者进行比较。在气管切开术之前和整个住院期间，使用了两个Cox比例风险模型来预测变量的无瓣膜形成。

结果

拔除中位数的时间为37天（四分位间距[IQR] 29-67）。气管切开术前与无环切术相关的变量包括糖尿病（HR，0.15; 95％CI，0.03-0.84; p = .03），开颅手术（HR，0.25; 95％CI，0.06-1.02; p = .05）和急性肾伤害（AKI）（HR，0.06； 95％CI，0.01-0.48；p = .01）。整个住院期间的变量包括年龄（HR，1.12； 95％CI，1.01-1.21；p = .03），呼吸机天数（HR，0.74； 95％CI，0.57-0.95；p = .02），再次插管（HR， 0.07; 95％CI，0.01-0.64; p = .02），抽吸（HR，0.01; 95％CI，0.0-0.29，p = .01），开颅手术（HR，0.004; 95％CI，0.0-0.39; p= .02）和AKI（HR，0.0； 95％CI，0.0-0.21；p = .01）。

结论

糖尿病，颅骨切开术和急性肾损伤的存在可能会为在进行气管切开术之前出现脱皮的机会提供信息。