Predictors of tracheostomy in patients with spontaneous intracerebral hemorrhage.
BACKGROUND
One third of patients with intracerebral hemorrhage (ICH) require mechanical ventilation; in most, tracheostomy may be necessary. Limited data exist about predictors of tracheostomy in ICH. The aim of our study is to identify predictors of tracheostomy in ICH.


METHODS
We reviewed medical records of patients seen in our institution between 2005 and 2009, using ICD-9 codes for ICH, for admission clinical and radiological parameters. A stepwise logistic regression model was used to identify tracheostomy predictors.


RESULTS
Ninety patients with ICH were included in the analysis, eleven of which required tracheostomy. Patients requiring a tracheostomy were more likely to have a large hematoma volume (≥30mL) (63.4% vs. 29.1%, p=0.037), intraventricular hemorrhage (81.8% vs. 27.8%, p<0.0001), hydrocephalus (81.8% vs. 8.8%, p<0.0001), admission GCS<8 (81.8% vs. 5.1%, p<0.0001), intubation≥14 days (54.5% vs. 1.27%, p<0.0001) and pneumonia (63.6% vs. 17.7%, p=0.003). Stepwise logistic regression yielded admission GCS (OR=80.55, p=0.0003) and intubation days (OR=87.49, p<0.006) as most important predictors.


CONCLUSIONS
We could potentially predict the need for tracheostomy early in the course of ICH based on the admission GCS score; duration of intubation is another predictor for tracheostomy. Early tracheostomy could decrease the time, and therefore risks of prolonged endotracheal intubation and length of hospital stay.
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States. shadiyaghi@yahoo.com
Shadi
S
Yaghi
Page
P
Moore
Bappaditya
B
Ray
Salah G
SG
Keyrouz
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D003422:Critical Care; D005260:Female; D005544:Forecasting; D015600:Glasgow Coma Scale; D006801:Humans; D038801:International Classification of Diseases; D020300:Intracranial Hemorrhages / Q000628:therapy*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy; D016896:Treatment Outcome