Optimal Tracheostomy Timing Through Modeling Based on Severity of Vocal Cord Injury.
BACKGROUND: Endotracheal intubation is a routinely performed procedure in the ICU. Whereas it is recognized that endotracheal intubation can result in laryngeal and tracheal injury, this study evaluated factors that may affect the incidence of posterior vocal cord ulcers (PVCUs). METHODS: One thousa...
| Publicado en: | Respiratory Care Vol. 68; no. 2; pp. 255 - 260 |
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| Autores principales: | , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=161464039&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 161464039 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2023 vid: 68 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 161464039 161464039 161464039 10.4187/respcare.10176 161464039 ppf: 255 ppct: 5 formats: fmt: @attributes: type: P tig: atl: Optimal Tracheostomy Timing Through Modeling Based on Severity of Vocal Cord Injury. aug: au: Malkoc, Aldin Nguyen, Danny T. Wong, Stephanie Wong, David T. affil: Arrowhead Regional Medical Center, Colton, California sug: subj: Time Factors Severity of Illness Ulcer Epidemiology Ulcer Risk Factors Vocal Cords Pathology Tracheostomy Human Retrospective Design Bronchoscopy Documentation Treatment Outcomes Ventilators, Mechanical Length of Stay Death Analysis of Variance Multivariate Analysis Kaplan-Meier Estimator Intubation, Intratracheal Adverse Effects Record Review Electronic Health Records Prospective Studies Descriptive Statistics Two-Tailed Test T-Tests Chi Square Test Logistic Regression Data Analysis Software Adult Middle Age Aged Male Female Length of Stay Evaluation Body Mass Index Evaluation Univariate Statistics Odds Ratio Confidence Intervals Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: Endotracheal intubation is a routinely performed procedure in the ICU. Whereas it is recognized that endotracheal intubation can result in laryngeal and tracheal injury, this study evaluated factors that may affect the incidence of posterior vocal cord ulcers (PVCUs). METHODS: One thousand three hundred fifty-five patients were retrospectively screened from 2002-2018 that received a tracheostomy with routine bronchoscopy at a single institution. Post tracheostomy operative notes were reviewed and included only if proper visualization of the vocal cords was documented. Primary outcome measures included presence of PVCU, length of time on a ventilator until a tracheostomy, hospital length of stay, and mortality. Stratification of the data focused on the severity of the ulcer (mild, moderate, and severe) and was analyzed using analysis of variance, multivariate analysis, and Kaplan-Meier modeling of PVCU incidence over time. RESULTS: We enrolled 192 subjects with documentation of vocal cord visualization. Thirty-nine subjects did not have a PVCU, whereas 153 subjects did. A median duration of 9 (interquartile range [IQR] 5-13) d was associated with developing a mild PVCU, whereas individuals intubated for a median of 6 (IQR 4-7) d were ulcer free. Statistical difference between length of time on a ventilator before tracheostomy and the severity of the PVCU seen was significant (P < .001). The Kaplan-Meier model showed that beyond 2 weeks of endotracheal intubation subjects will have > 80% chance of developing a moderate vocal cord ulcer. Whereas by day 7, there is only a 20% chance of developing a moderate ulcer. CONCLUSIONS: Earlier tracheostomy placement was associated with reduced severity of vocal cord ulcer formation. The Kaplan-Meier model suggests that waiting for 14 d is likely too long and earlier placement of a tracheostomy, within a week, may decrease the morbidity of posterior vocal cord injury. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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