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Title: Factors associated with short versus prolonged tracheostomy length of cannulation and the relationship between length of cannulation and adverse events.
Austin Authors: Zaga, Charissa J ;Sweeney, Joanne M ;Cameron, Tanis S ;Campbell, Matthew C ;Warrillow, Stephen J ;Howard, Mark E 
Affiliation: Respiratory and Sleep Medicine
Speech Pathology
Institute for Breathing and Sleep
Tracheostomy Review and Management Service
Ear Nose Throat / Head and Neck Surgery
Intensive Care
Issue Date: Sep-2022 2021
Publication information: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses 2022; 35(5): 535-542
Abstract: Tracheostomy management and care is multifaceted and costly, commonly involving complex patients with prolonged hospitalisation. Currently, there are no agreed definitions of short and prolonged length of tracheostomy cannulation (LOC) and no consensus regarding the key factors that may be associated with time to decannulation. The aims of this study were to identify the factors associated with short and prolonged LOC and to examine the number of tracheostomy-related adverse events of patients who had short LOC versus prolonged LOC. A retrospective observational study was undertaken at a large metropolitan tertiary hospital. Factors known at the time of tracheostomy insertion, including patient, acuity, medical, airway, and tracheostomy factors, were analysed using Cox proportional hazards model and Kaplan-Meier survival curves, with statistically significant factors then analysed using univariate logistic regression to determine a relationship to short or prolonged LOC as defined by the lowest and highest quartiles of the study cohort. The number of tracheostomy-related adverse events was analysed using the Kaplan-Meier survival curve. One hundred twenty patients met the inclusion criteria. Patients who had their tracheostomy performed for loss of upper airway were associated with short LOC (odds ratio [OR]: 2.30 (95% confidence interval [CI]: 1.01-5.25) p = 0.049). Three factors were associated with prolonged LOC: an abdominal/gastrointestinal tract diagnosis (OR: 5.00 [95% CI: 1.40-17.87] p = 0.013), major surgery (OR: 2.51 [95% CI: 1.05-6.01] p = 0.038), and intubation for >12 days (OR: 0.30 [95% CI: 0.09-0.97] p = 0.044). Patients who had one or ≥2 tracheostomy-related adverse events had a high likelihood of prolonged LOC (OR: 5.21 [95% CI: 1.95-13.94] p = ≤0.001 and OR: 12.17 [95% CI: 2.68-55.32] p ≤ 0.001, respectively). Some factors that are known at the time of tracheostomy insertion are associated with duration of tracheostomy cannulation. Tracheostomy-related adverse events are related to a high risk of prolonged LOC.
DOI: 10.1016/j.aucc.2021.09.003
Journal: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
PubMed URL: 34742631
ISSN: 1036-7314
Type: Journal Article
Subjects: Adverse events
Length of cannulation
Appears in Collections:Journal articles

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