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Early Versus Delayed Tracheostomy in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Early Versus Delayed Tracheostomy in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease./
作者:	Mohamed, Yahia .
面頁冊數:	1 online resource (62 pages)
附註:	Source: Masters Abstracts International, Volume: 82-03.
Contained By:	Masters Abstracts International82-03.
標題:	Bioinformatics. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28086836click for full text (PQDT)
ISBN:	9798664738032

Early Versus Delayed Tracheostomy in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease.
Mohamed, Yahia .

Early Versus Delayed Tracheostomy in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease. - 1 online resource (62 pages)

Source: Masters Abstracts International, Volume: 82-03.

Thesis (M.S.)--University of Missouri - Kansas City, 2020.

Includes bibliographical references

Background: Acute respiratory failure due to the acute exacerbation of chronic obstructive pulmonary disease (COPD) may need intensive care unit (ICU) admission and invasive ventilation that places COPD patients at a higher risk of prolonged ventilation. Tracheostomy procedures are widely used in the ICU to help wean patients who need prolonged ventilation. The optimal timing for tracheostomy remains controversial. We examined whether early tracheostomy in mechanically ventilated patients who have COPD was associated with lower 90-day all-cause in-hospital mortality.Methods: This retrospective analysis used the Health Facts database to study 72585 COPD patients who were hospitalized and mechanically ventilated between January 1, 2009, and June 29, 2018. The cohort was further limited to those receiving tracheostomy. Receiver operating characteristic (ROC) curve was used to define the most sensitive cut-off for the timing of tracheostomy for predicting 90-day mortality. The threshold was used to create the early and late tracheostomy groups. Multivariate logistic regression models, Generalized Linear Model, and Chi-square test were used to compare outcomes among patients who received an early tracheostomy and late tracheostomy.Results: A total of 1728 patients met the inclusion criteria. The most sensitive cut-off for timing of tracheostomy was the 9th day of mechanical ventilation, which was the threshold used to create the early and late tracheostomy groups; 617 received an early tracheostomy and 1111 received a late tracheostomy. 90-day all-cause in-hospital mortality was significantly lower in the early group compared with a late group (15.24% vs 22.41%; Odds ratio, 0.632; 95% CI, 0.485-0.823) (P= 0.0006). Tracheostomy related complications were significantly higher in the early group (6.16% vs 4.5%; Odds ratio, 1.62; 95% CI, 1.041- 2.523) (P=0.0326). The risk of aspiration pneumonitis was not statistically different between both groups (Odds ratio, 0.771; 95% CI, 0.588-1.01) (P=0.059). The hospital length of stay was significantly lower in the early group compared with a late group (Median, 19 vs 29; Odds ratio, 0.709; 95% CI, 0.669-0.743) (P=<0.001).Conclusion: Early tracheostomy in mechanically ventilated COPD patients was associated with lower 90-day all-cause in-hospital mortality and hospital length of stay. However, they had a higher risk for tracheostomy complications. Further studies are required to explore factors that help clinicians predict which patients need prolonged ventilation.

Electronic reproduction.
Ann Arbor, Mich. :
ProQuest,
2023

Mode of access: World Wide Web

ISBN: 9798664738032Subjects--Topical Terms:

553671
Bioinformatics.
Subjects--Index Terms:

TracheostomyIndex Terms--Genre/Form:

542853
Electronic books.

Early Versus Delayed Tracheostomy in Mechanically Ventilated Patients with Chronic Obstructive Pulmonary Disease.
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