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Research ArticleOriginal Contributions

Time to Wean After Tracheotomy Differs Among Subgroups of Critically Ill Patients: Retrospective Analysis in a Mixed Medical/Surgical Intensive Care Unit

Ary-Jan WJ van der Lely, Denise P Veelo, Dave A Dongelmans, Johanna C Korevaar, Margreeth B Vroom and Marcus J Schultz
Respiratory Care December 2006, 51 (12) 1408-1415;
Ary-Jan WJ van der Lely
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Denise P Veelo
Departments of Intensive Care Medicine and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Dave A Dongelmans
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Johanna C Korevaar
Departments of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Margreeth B Vroom
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Marcus J Schultz
Department of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Abstract

OBJECTIVE: To determine the time to wean from mechanical ventilation and time spent off the ventilator per day after tracheotomy in critically ill patients in a 28-bed mixed medical and surgical intensive care unit (ICU) in Amsterdam, Netherlands.

METHODS: We conducted a retrospective analysis of consecutive patients during the 14-month period from November 1, 2003, through January 1, 2005. Included were translaryngeally intubated mechanically ventilated patients who received a tracheotomy during their ICU stay.

RESULTS: Of all the patients admitted to the ICU, 129 (7%) received a tracheotomy. Significantly more tracheotomies were performed in neurosurgery/neurology patients and in those admitted for acute conditions (16% and 12%, respectively). Tracheotomy was performed a median 8 days (interquartile range 4–13 d) after ICU admission. For all the patients, the median time to wean after tracheotomy was 5 days (interquartile range 2–11 d). Neurosurgery/neurology patients and patients in the cardiology subgroup needed significantly less time to wean from mechanical ventilation than did patients in other subgroups (3 d, interquartile range 2–7 d, and 3 d, interquartile range 2–5 d, respectively, p < 0.05). There was a significant association between admission group and neurological status at the time of tracheotomy. A low Glasgow coma scale score was associated with shorter time to wean. Within 1 week after tracheotomy, the probability of the patient having breathed spontaneously, without ventilator assistance, for > 4 h/d was 89%, 78% for > 8 h/d, and 72% for > 12 h/d. By day 28, the probability of the patient having breathed spontaneously for > 4 h/d was 98%, 97% for > 8 h/d, and 94% for > 12 h/d.

CONCLUSION: Time to wean from after tracheotomy differed among the subgroups in our ICU. After tracheotomy, the majority of patients were quickly able to breathe spontaneously without assistance of the mechanical ventilator for several hours per day. Patients who require tracheotomy only for airway protection wean sooner than other patients.

  • artificial respiration
  • tracheotomy
  • respiratory failure
  • ventilator weaning

Footnotes

  • Correspondence: Marcus J Schultz MD PhD, Department of Intensive Care Medicine, C3-329, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. E-mail: m.j.schultz{at}amc.uva.nl..
  • The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2006 by Daedalus Enterprises Inc.
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Respiratory Care: 51 (12)
Respiratory Care
Vol. 51, Issue 12
1 Dec 2006
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Time to Wean After Tracheotomy Differs Among Subgroups of Critically Ill Patients: Retrospective Analysis in a Mixed Medical/Surgical Intensive Care Unit
Ary-Jan WJ van der Lely, Denise P Veelo, Dave A Dongelmans, Johanna C Korevaar, Margreeth B Vroom, Marcus J Schultz
Respiratory Care Dec 2006, 51 (12) 1408-1415;

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Time to Wean After Tracheotomy Differs Among Subgroups of Critically Ill Patients: Retrospective Analysis in a Mixed Medical/Surgical Intensive Care Unit
Ary-Jan WJ van der Lely, Denise P Veelo, Dave A Dongelmans, Johanna C Korevaar, Margreeth B Vroom, Marcus J Schultz
Respiratory Care Dec 2006, 51 (12) 1408-1415;
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Keywords

  • artificial respiration
  • tracheotomy
  • respiratory failure
  • ventilator weaning

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