The importance of tracheostomy to the weaning success in patients with conscious disturbance in the respiratory care center

• Main Authors: Yu-chan Lee, 李玉嬋
• Other Authors: Cheng-Deng Kuo
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/50480909688113201890

碩士 === 國立陽明大學 === 急重症醫學研究所 === 104 === Background: When to extubate the endotracheal tube is controversial in patients with depressed mental status. The use of Glasgow coma scale (GCS) with score 8 and above as a criterion of extubation by many investigators is questionable. Methods: A total of 133 consecutive patients (M/F: 86/47; age: 71±17 years) admitted to the Respiratory Care Center (RCC) of the hospital were enrolled. The effects of GCS on the outcomes and weaning rate of the patients were evaluated. Results: The mortality rate was significantly higher in patients with GCS < 7T or derived GCS (dGCS) <10 (p = 0.011). In patients with low GCS (GCS< 7T or dGCS <10), the rate of successful ventilator weaning in patients with tracheostomy was significantly higher than that in patients without tracheostomy (GCS and dGCS: 94.4% vs. 38.5%, p = 0.001). However, the tracheostomy in patients with high GCS (GCS ≥ 7T or dGCS ≥ 10) did not lead to a higher success rate of weaning. In multivariable analysis, tracheostomy still an independent determinant of successful weaning in patients with low GCS. Conclusion: Tracheostomy increases the success rate of weaning in patients with low GCS, but not in patients with high GCS. Mental status graded by GCS did affect the outcomes in patients with conscious disturbance in the RCC. The low tracheostomy rate in patients with low GCS affected the successful weaning rate, which might contribute to the higher mortality rate in patients with low GCS in the RCC.