Περίληψη:
Background and Purpose: Ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients often require endotracheal intubation (EI) and mechanical ventilation (MV). Predicting the need for prolonged EI and timing of tracheostomy (TR) is challenging. While TR is performed for about 10–15% of patients in the general intensive care unit (ICU), the rate in the neurological ICU and for stroke patients ranges between 15 and 35%. Thus, we performed an external validation of the recently published SETscore. Methods: This is a retrospective review for all patients with IS, non-traumatic ICH, and SAH who required intubation within 48 h of admission to the neurological ICU. We compared the SETscore between tracheostomized versus successfully extubated patients, and early TR (within 7 days) versus late TR (after 7 days). Results: Out of 511 intubated patients, 140 tracheostomized and 105 extubated were included. The sensitivity for a SETscore > 10 to predict the need for TR was 81% (95% CI 74–87%) with a specificity of 57% (95% CI 48–67%). The score had moderate accuracy in correctly identifying those requiring TR and those successfully extubated: 71% (95% CI 65–76%). The AUC of the score was 0.74 (95% CI 0.68–0.81). Multivariable logistic regression models were used to identify other independent predictors of TR. After including body mass index (BMI), African American (AA) race, ICH and a positive sputum culture in the SETscore, sensitivity, specificity, overall accuracy, and AUC improved to 90%, 78%, 85%, and 0.89 (95% CI 0.85–0.93), respectively. In our cohort, performing early TR was associated with improvement in the ICU median length of stay (LOS) (15 vs 20.5 days; p = 0.002) and mean ventilator duration (VD) (13.4 vs 18.2 days; p = 0.005) in comparison to late TR. Conclusions: SETscore is a simple score with a moderate accuracy and with a fair AUC used to predict the need for TR after MV for IS, ICH, and SAH patients. Our study also demonstrates that early TR was associated with a lower ICU LOS and VD in our cohort. The utility of this score may be improved when including additional variables such as BMI, AA race, ICH, and positive sputum cultures. © 2018, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
Συγγραφείς:
Alsherbini, K.
Goyal, N.
Metter, E.J.
Pandhi, A.
Tsivgoulis, G.
Huffstatler, T.
Kelly, H.
Elijovich, L.
Malkoff, M.
Alexandrov, A.
Λέξεις-κλειδιά:
accuracy; adult; African American; Article; artificial ventilation; body mass; brain hemorrhage; brain ischemia; cohort analysis; controlled study; dysphagia; extubation; female; hospital admission; human; length of stay; logistic regression analysis; major clinical study; male; neurologic disease assessment; neurological intensive care unit; predictor variable; priority journal; race difference; respiratory tract intubation; retrospective study; scoring system; sensitivity and specificity; sputum culture; Stroke Related Early Tracheostomy Score; subarachnoid hemorrhage; time to treatment; tracheostomy; validation study; aged; brain hemorrhage; brain ischemia; cerebrovascular accident; clinical decision making; endotracheal intubation; intensive care; middle aged; subarachnoid hemorrhage; tracheostomy, Adult; Aged; Brain Ischemia; Cerebral Hemorrhage; Clinical Decision-Making; Critical Care; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Respiration, Artificial; Retrospective Studies; Stroke; Subarachnoid Hemorrhage; Tracheostomy
