title: The importance of tracheostomy to the weaning success in patients with conscious disturbance in the respiratory care center.
abstract: BACKGROUND
  When to extubate the endotracheal tube is controversial in patients with depressed mental status. The use of the Glasgow Coma Scale (GCS) with score 8 or above as a criterion for extubation by many investigators is questionable.
  
  
  METHODS
  A total of 133 consecutive patients (M/F: 86/47; age: 71 ± 17 years) admitted to the respiratory care center (RCC) of the hospital were enrolled. The effects of GCS score on the outcomes and weaning rate of the patients were evaluated.
  
  
  RESULTS
  The mortality rate was significantly higher in patients with a GCS score<7T or derived GCS (dGCS) score < 10 (p = 0.011). In patients with a low GCS score (GCS < 7T or dGCS score < 10), the rate of successful ventilator weaning in patients with tracheostomy was significantly higher than that in patients without tracheostomy (GCS and dGCS: 94.4% vs. 38.5%, p = 0.001). However, tracheostomy in patients with a high GCS (GCS score ≥ 7T or dGCS score ≥ 10) did not lead to a higher success rate of weaning. In multivariable analysis, tracheostomy was still an independent determinant of successful weaning in patients with low GCS.
  
  
  CONCLUSIONS
  Tracheostomy increases the success rate of weaning in patients with low GCS, but not in patients with high GCS. Mental status graded by GCS did affect the outcomes in patients with conscious disturbance in the RCC. The low tracheostomy rate in patients with low GCS affected the rate of successful weaning, which might have contributed to the higher mortality rate in patients with low GCS in the RCC.
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Yu-Chan
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Hao-Chien
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Hsu
authors.affiliation: Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan, ROC; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Huey-Dong
authors.initials: HD
authors.lastname: Wu
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Han-Shui
authors.initials: HS
authors.lastname: Hsu
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Laboratory of Biophysics, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: cdkuo23@gmail.com.
authors.forename: Cheng-Deng
authors.initials: CD
authors.lastname: Kuo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D014139:Tracheostomy
keywords: Glasgow Coma Scale; extubation; respiratory care center; tracheostomy; weaning