title: Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan.
abstract: BACKGROUND
  Determining the optimal time for performing a tracheostomy and weaning a patient off a ventilator is typically challenging for physicians, respiratory therapists, patients and patients' families.
  
  
  OBJECTIVE
  This study examined the factors influencing tracheostomy timing and ventilator weaning and described the transition-care placement of patients who experience unsuccessful ventilator weaning.
  
  
  METHODS
  A retrospective design was employed, and 2 years of data were collected through a medical chart review performed at a hospital in Northern Taiwan. Sixty patients who received tracheostomies in the intensive care unit (ICU) or respiratory care center were enrolled. The data included each patient's demographic information, disease diagnosis, and Glasgow Coma Scale score and Acute Physiology and Chronic Health Evaluation II scores.
  
  
  RESULTS
  For patients on a ventilator in an ICU, the tracheostomy rate was 2.7%. Early (within 21 days) and late (>21 days) tracheostomies accounted for 36.7% and 63.3%, respectively. Of the patients who had received tracheostomies, 36.7% experienced ventilator weaning. The factors related to tracheostomy timing were disease diagnosis (P = 0.036) and days of ventilator use (P = 0.003). The factors related to ventilator weaning included disease diagnosis (P = 0.010) and tracheostomy timing (P = 0.001). Early tracheostomies were 10.9 times more likely than late tracheostomies to result in ventilator weaning (95%CI =2.5-47.7, P = 0.002).
  
  
  CONCLUSIONS
  Tracheostomy timing was strongly correlated with ventilator weaning. Early tracheostomy was higher successful ventilator weaning rates. The surgical patients were more likely to receive an early tracheostomy. However, the number of patients in Taiwan who received tracheostomies was lower than that in other countries. Further study maybe need to understand cultural variations in the acceptance of tracheostomies by patients.
authors.affiliation: College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Chen
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Lixin
authors.initials: L
authors.lastname: Song
authors.affiliation: Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.|Department of Respiratory Therapy, Lo-Tung Poh-Ai Hospital, I-Lan, Taiwan.
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Chang
authors.affiliation: College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Min-Tao
authors.initials: MT
authors.lastname: Hsu
mesh_terms: D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects*; D015300:Ventilator Weaning / Q000379:methods*
keywords: respiratory care; timing; tracheostomy; ventilator weaning