|
Distribution of decannulation recommendations according to clinician and patient scenario characteristics |
|||
| Characteristics |
Decannulation recommendation |
P valuea |
|
|
|
|||
| Yes |
No |
||
| (n = 355) |
(n = 320) |
||
|
|
|||
| Clinician characteristics |
|||
| Profession |
0.860 |
||
| Physician |
274 (77) |
245 (77) |
|
| Respiratory therapist |
81 (23) |
75 (23) |
|
| Time since graduation in years (standard deviation) |
18.9 (9.1) |
18.4 (8.5) |
0.452 |
| Principal work facility |
0.041 |
||
| Acute care |
282 (79) |
234 (73) |
|
| Weaning |
47 (13) |
52 (16) |
|
| Rehabilitation |
16 (4) |
14 (4) |
|
| Chronic care |
9 (2) |
21 (7) |
|
| Experience with tracheostomized patients |
0.349 |
||
| 0–5 years |
34 (10) |
44 (14) |
|
| 6–10 years |
85 (24) |
65 (20) |
|
| 11–20 years |
134 (38) |
115 (36) |
|
| >20 years |
102 (29) |
96 (30) |
|
| Number of tracheostomy patients cared for per year |
0.406 |
||
| 0–20 patients |
62 (17) |
49 (15) |
|
| 21–50 patients |
101 (28) |
103 (32) |
|
| 51–100 patients |
128 (36) |
100 (31) |
|
| >100 patients |
64 (18) |
68 (21) |
|
| Number of tracheostomized patients decannulated per year |
0.958 |
||
| 0–1 patients |
45 (13) |
39 (12) |
|
| 2–5 patients |
65 (18) |
52 (16) |
|
| 6–10 patients |
68 (19) |
64 (20) |
|
| 11–20 patients |
63 (18) |
57 (18) |
|
| >20 patients |
114 (32) |
108 (34) |
|
| Patient scenario characteristics |
|||
| Scenario |
0.707 |
||
| Stroke |
81 (23) |
85 (27) |
|
| Primary respiratory failure |
84 (24) |
75 (23) |
|
| Abdominal aortic aneurysm |
98 (28) |
84 (26) |
|
| Trauma |
92 (26) |
76 (24) |
|
| Age |
0.103 |
||
| 45 years |
187 (53) |
147 (46) |
|
| 75 years |
168 (47) |
173 (54) |
|
| Comorbidities |
0.569 |
||
| None |
182 (51) |
157 (49) |
|
| End-stage renal disease |
173 (49) |
163 (51) |
|
| Etiology of respiratory failure |
0.030 |
||
| Chronic obstructive pulmonary disease |
192 (54) |
144 (45) |
|
| Pneumonia |
163 (46) |
176 (55) |
|
| Difficulty of intubation |
0.089 |
||
| Easy |
190 (54) |
149 (47) |
|
| Difficult |
165 (46) |
171 (53) |
|
| Level of consciousness |
<0.001 |
||
| Alert and interactive |
248 (70) |
127 (40) |
|
| Drowsy but arousable |
107 (30) |
193 (60) |
|
| Ability to tolerate capping |
0.626 |
||
| 24 hours |
174 (49) |
163 (51) |
|
| 72 hours |
181 (51) |
157 (49) |
|
| Cough effectiveness |
<0.001 |
||
| Strong cough |
221 (62) |
117 (37) |
|
| Weak cough |
134 (38) |
203 (63) |
|
| Secretions |
<0.001 |
||
| Scant thin |
196 (55) |
129 (40) |
|
| Moderate thick |
159 (45) |
191 (60) |
|
| Swallowing function |
<0.001 |
||
| Nil per os |
233 (66) |
262 (82) |
|
| Eating Jell-O and pudding |
122 (34) |
58 (18) |
|
| Respiratory rate |
0.129 |
||
| 18 breaths per minute |
182 (51) |
146 (46) |
|
| 28 breaths per minute |
173 (49) |
174 (54) |
|
| Oxygenation, 95% saturation |
|||
| Fraction of inspired oxygen of 0.30 |
197 (56) |
135 (42) |
|
| Fraction of inspired oxygen of 0.50 |
158 (44) |
185 (58) |
0.001 |
|
Data are expressed as number (percentage) unless otherwise indicated. aP value for the comparison of clinical case scenarios in which decannulation was recommended with those in which it was not. The 675 decannulation recommendations are clustered within 225 clinicians. P values were calculated by generalized estimating equation and robust estimates of variance. | |||
Stelfox et al. Critical Care 2008 12:R26 doi:10.1186/cc6802 |
|||