title: The indication of tracheotomy conditions the predictors of time to decannulation in critical patients.
abstract: OBJECTIVE
  Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation.
  
  
  METHODS
  A prospective, observational cohort study was carried out.
  
  
  METHODS
  Two medical-surgical ICUs.
  
  
  METHODS
  We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2).
  
  
  METHODS
  Patients were weaned and decannulated according to established protocols.
  
  
  METHODS
  We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included Cox-proportional multivariate analysis with time to decannulation as the dependent variable.
  
  
  RESULTS
  A total of 227 patients were tracheostomized in the ICUs; of these, 151 were finally included in the study. In the multivariate analysis, time to decannulation in Group 1 was associated with the male gender (HR 1.74 (1.04-2.89), p= 0.03), age>60 years (HR 0.58 (0.36-0.91), p= 0.02), high suctioning frequency (HR 0.81 (0.67-0.97), p= 0.02), low forced vital capacity (HR 0.48 (0.28-0.82), p<0.01), and low peak flow (HR 0.25 (0.14-0.46), p<0.01). In Group 2 time to decannulation was associated to GCS >13 (HR 2.73 (1.51-4.91), p<0.01), high suctioning frequency (HR 0.7 (0.54-0.91), p<0.01), and inadequate swallowing (HR 1.97 (1.11-3.52), p=0.02).
  
  
  CONCLUSIONS
  Variables associated with longer time to decannulation in ICU-tracheostomized patients differ with the indications for tracheostomy.
authors.affiliation: Servicio de Cuidados Intensivos, Hospital Infanta Sofía, Madrid, Spain. ghernandezm@telefonica.net
authors.forename: G
authors.initials: G
authors.lastname: Hernández
authors.forename: R
authors.initials: R
authors.lastname: Ortiz
authors.forename: A
authors.initials: A
authors.lastname: Pedrosa
authors.forename: R
authors.initials: R
authors.lastname: Cuena
authors.forename: C
authors.initials: C
authors.lastname: Vaquero Collado
authors.forename: P
authors.initials: P
authors.lastname: González Arenas
authors.forename: S
authors.initials: S
authors.lastname: García Plaza
authors.forename: A
authors.initials: A
authors.lastname: Canabal Berlanga
authors.forename: R
authors.initials: R
authors.lastname: Fernández
mesh_terms: D015331:Cohort Studies; D016638:Critical Illness / Q000145:classification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D014139:Tracheostomy; D014140:Tracheotomy; D015300:Ventilator Weaning