Skip Navigation LinksHome > May 2006 - Volume 60 - Issue 5 > Predicting the Need for Early Tracheostomy: A Multifactorial...
Journal of Trauma-Injury Infection & Critical Care:
doi: 10.1097/01.ta.0000217270.16860.32
Original Articles

Predicting the Need for Early Tracheostomy: A Multifactorial Analysis of 992 Intubated Trauma Patients

Goettler, Claudia E. MD, FACS; Fugo, Jonathan R. DO; Bard, Michael R. MD; Newell, Mark A. MD, FACS; Sagraves, Scott G. MD, FACS; Toschlog, Eric A. MD, FACS; Schenarts, Paul J. MD, FACS; Rotondo, Michael F. MD, FACS

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Abstract

Background: Tracheostomy has few, severe risks, while prolonged endotracheal intubation causes morbidity. The need for tracheostomy was assessed, based on early clinical parameters.

Methods: Adult trauma patients (January 1994–August 2004), intubated for resuscitation, ventilated >24 hours, were retrospectively evaluated for demographics, physiology, brain, and pulmonary injury. Tracheostomy patients were compared with those without. Chi-square, Mann-Whitney, and multivariate logistic regression were used with statistical significance at p < 0.05.*

Results: Of 992 patients, 430 (43%) underwent tracheostomy at 9.22 ± 5.7 days. Risk factors were age (45.6* ± 18.8 vs. 36.7 ± 15.9, OR: 2.1 (18 years increments), ISS (30.3* ± 12.5 vs. 22.0 ± 10.3, OR: 2.1 (12u increments), damage control (DC) [68%*(n = 51) vs. 32%*(n = 51), OR: 3.8], craniotomy [70%*(n = 21) versus 30%(n = 9), OR: 2.6], and intracranial pressure monitor (ICP) [65.4%*(n = 87) vs. 34.6%(n = 46), OR: 2.1].

A 100% tracheostomy rate (n = 30, 3.0%) occurred with ISS (injury severity score) = 75, ISS ≥50, and age ≥55, admit/24 hour GCS (Glasgow Coma Scale) = 3 and age ≥70, AIS abdomen, chest or extremities ≥5 and age ≥60, bilateral pulmonary contusions (BPC) and ≥8 rib fractures, craniotomy and age ≥50, craniotomy with intracranial pressure (ICP) and age ≥40, or craniotomy and GCS ≤4 at 24 hour.

A tracheostomy rate of ≥90% (n = 105, 10.6%) was found with ISS ≥54, ISS ≥40, and age ≥40, admit/24 hour GCS = 3 and age ≥55, paralysis and age ≥40, BPC and age ≥55.

A tracheostomy rate ≥80% (n = 248, 25.0%) occurred with ISS ≥38, age ≥80, admit/24 hour GCS = 3 and age ≥45, DC and age ≥50, BPC and age ≥50, aspiration and age ≥55, craniotomy with ICP, craniotomy with GCS ≤9 at 24 hour.

Conclusion: Discrete risk factors predict the need for tracheostomy for trauma patients. We recommend that patients with ≥90% risk undergo early tracheostomy and that it is considered in the ≥80% risk group to potentially decreased morbidity, increased patient comfort, and optimize resource utilization.

© 2006 Lippincott Williams & Wilkins, Inc.

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