Time to decannulation and associated risk factors in the postacute rehabilitation of critically ill patients with intensive care unit-acquired weakness: a cohort study.
BACKGROUND
Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU-acquired muscle weakness (ICUAW) is not well known.


OBJECTIVE
The aim of our study was to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness.


METHODS
This is a cohort study.


METHODS
Postacute and rehabilitation units.


METHODS
Chronic critically ill patients with ICUAW and tracheostomy tube.


METHODS
We calculated the time until decannulation and used possible predictor variables to explain this time course.


RESULTS
We included 122 patients with ICUAW. Successful decannulation of the tracheostomy tube was achieved after a median of 40.5 days (interquartile range= 44) after study onset and after a median of 89 days (interquartile range= 58) after onset of primary illness. Our final multivariate Cox-Proportional Hazard model included two main risk factors for decannulation: the amount of medical tubes such as catheters at admission to the rehabilitation center (adjusted hazard ratio [HR]=1.572 (95% CI: 1.021 to 2.415) and the duration of weaning from respirator in days (adjusted HR= 1.02 per day (95% CI: 1.006 to 1.03). No adverse events occurred.


CONCLUSIONS
We described the detailed time course of decannulation in the rehabilitation of chronic critically ill patients and no adverse events were observed. Taken many single factors into account the quantity of medical tubes and the duration of weaning from respirator were associated risk factors for decannulation in this population.


CONCLUSIONS
Knowing an exact time course of decannulation supports medical decisions in clinical rehabilitation and might help to give a prognosis for decannulation. The amount of medical tubes and the duration of weaning from respirator may highly influence decannulation.
Scientific Institute, Private European Medical Academy of the Bavaria Clinic, Kreischa, Germany.
Simone
S
Thomas
Private Hospital, Bavaria Clinic, Kreischa, Germany.
Wolfgang
W
Sauter
City Clinic, Munich, Germany.
Ulrike
U
Starrost
Hochschule, Gera, Germany.
Marcus
M
Pohl
Scientific Institute, Private European Medical Academy of the Bavaria Clinic, Kreischa, Germany - jan.mehrholz@klinik-bavaria.de.|Department of Public Health, Faculty of Medicine &quot;Carl Gustav Carus&quot;, Technical University of Dresden, Dresden, Germany.
Jan
J
Mehrholz
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000534:rehabilitation; D015331:Cohort Studies; D016638:Critical Illness / Q000534:rehabilitation*; D020878:Device Removal; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation*; D016896:Treatment Outcome