title: Prediction of prolonged mechanical ventilation in patients in the intensive care unit A cohort study.
abstract: BACKGROUND
  There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients.
  
  
  METHODS
  This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation.
  
  
  RESULTS
  163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation.
  
  
  CONCLUSIONS
  It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.
authors.affiliation: Head and neck service. Department of Surgery. Fundación Abood Shaio. Bogota. Colombia ; Department of Surgery. Universidad de La Sabana. Chía, Colombia.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanabria
authors.affiliation: Head and neck service. Department of Surgery. Fundación Abood Shaio. Bogota. Colombia.
authors.forename: Ximena
authors.initials: X
authors.lastname: Gómez
authors.affiliation: Department of Surgery. Universidad de La Sabana. Chía, Colombia.
authors.forename: Valentín
authors.initials: V
authors.lastname: Vega
authors.affiliation: Department of Surgery. Universidad de La Sabana. Chía, Colombia.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Domínguez
authors.affiliation: Department of Surgery. Universidad de La Sabana. Chía, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Osorio
keywords: artificial respiration; intensive care units; intratracheal intubation; risk factors; tracheostomy; ventilator weaning