title: I-TRACH: Validating A Tool for Predicting Prolonged Mechanical Ventilation.
abstract: OBJECTIVE
  We previously developed a bedside model (I-TRACH), which used commonly obtained data at the time of intubation to predict the duration of mechanical ventilation (MV). We now sought to validate this in a prospective trial.
  
  
  METHODS
  A prospective, observational study of 225 consecutive adult medical intensive care unit patients requiring MV. Utilizing the original 6 variables used in the I-TRACH model (Intubation in the ICU, Tachycardia [heart rate > 110], Renal dysfunction [blood urea nitrogen > 25], Acidemia [pH < 7.25], Creatinine [>2.0 or >50% increase from baseline values], and decreased HCO3[<20]), we (1) confirmed that these were still predictive of length of MV by multivariate analysis and (2) assessed the correlation between the number of criteria met and the subsequent duration of MV. In addition, we compared the performance of I-TRACH to Acute Physiology Age Chronic Health Evaluation-II and III, Sequential Organ Failure Assessment, and Acute Physiology Score as predictors of length of MV.
  
  
  RESULTS
  Mean age was 62.6 ± 18.7 years, with a mean duration of MV of 5.8 ± 5.7 days. The number of I-TRACH criteria met directly correlated with the duration of MV. Individuals with ≥4 criteria were significantly more likely to require MV >7 and >14 days. Similarly, those who remained on ventilators for both >7 and >14 days met significantly more I-TRACH criteria than those requiring shorter durations of MV (1.7 ± 1.3 vs 2.8 ± 1.3 vs 3.8 ± 1.3 criteria, P < .001). I-TRACH performed better than all other models used to predict the duration of MV.
  
  
  CONCLUSIONS
  Similar to our previous retrospective study, these findings validate I-TRACH in determining the subsequent need for MV >7 and >14 days at the time of intubation.
authors.affiliation: 1 Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Clark
authors.affiliation: 1 Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Inocencio
authors.affiliation: 1 Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.|2 Department of Medicine, Uniformed Services University, Bethesda, MD, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lettieri
mesh_terms: D000138:Acidosis / Q000097:blood; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013610:Tachycardia / Q000150:complications; D013997:Time Factors; D015300:Ventilator Weaning
chemical_list: D001639:Bicarbonates; D003404:Creatinine
keywords: I-TRACH; mechanical ventilatory support; medical intensive care unit; predictive model; prolonged mechanical ventilation