Time to Wean After Tracheotomy Differs Among Subgroups of Critically Ill Patients: Retrospective Analysis in a Mixed Medical/Surgical Intensive Care Unit

Abstract

OBJECTIVE:

To determine the time to wean from mechanical ventilation and time spent off the ventilator per day after tracheotomy in critically ill patients in a 28-bed mixed medical and surgical intensive care unit (ICU) in Amsterdam, Netherlands.

METHODS:

We conducted a retrospective analysis of consecutive patients during the 14-month period from November 1, 2003, through January 1, 2005. Included were translaryngeally intubated mechanically ventilated patients who received a tracheotomy during their ICU stay.

RESULTS:

Of all the patients admitted to the ICU, 129 (7%) received a tracheotomy. Significantly more tracheotomies were performed in neurosurgery/neurology patients and in those admitted for acute conditions (16% and 12%, respectively). Tracheotomy was performed a median 8 days (interquartile range 4–13 d) after ICU admission. For all the patients, the median time to wean after tracheotomy was 5 days (interquartile range 2–11 d). Neurosurgery/neurology patients and patients in the cardiology subgroup needed significantly less time to wean from mechanical ventilation than did patients in other subgroups (3 d, interquartile range 2–7 d, and 3 d, interquartile range 2–5 d, respectively, p < 0.05). There was a significant association between admission group and neurological status at the time of tracheotomy. A low Glasgow coma scale score was associated with shorter time to wean. Within 1 week after tracheotomy, the probability of the patient having breathed spontaneously, without ventilator assistance, for > 4 h/d was 89%, 78% for > 8 h/d, and 72% for > 12 h/d. By day 28, the probability of the patient having breathed spontaneously for > 4 h/d was 98%, 97% for > 8 h/d, and 94% for > 12 h/d.

CONCLUSION:

Time to wean from after tracheotomy differed among the subgroups in our ICU. After tracheotomy, the majority of patients were quickly able to breathe spontaneously without assistance of the mechanical ventilator for several hours per day. Patients who require tracheotomy only for airway protection wean sooner than other patients.