Factors Determining the Timing of Tracheostomy in Medical ICU of a Tertiary Referral Hospital
유철규 (서울대학교)
Jinwoo Lee (Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea)
이상민 (서울대학교)
임재준 (서울대학교)
김영환 (서울대학교)
한성구 (서울대학교)
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Abstract
Background: Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU). Methods: Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study. Results: Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p＜0.001), days before tracheostomy (10 vs. 18, p＜0.001), time delay for tracheostomy (2.1 vs. 3.0,p＜0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and PaO2/FiO2＜300 mm Hg (61.9% vs. 91.1%, p=0.011)were different between the two groups. In multivariate analysis, APACHE II scores≥20 (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14∼136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11∼3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks. Conclusion: APACHE II scores≥20 and time delay for tracheostomy were associated with tracheostomy after 2 weeks.
- keywords
- APACHE, Intensive Care Units, Time, Tracheostomy
참고문헌
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