Analysis Of Related Factors Affecting The Timing Of Tracheotomy In Patients With Traumatic Brain Injury

Objective:Patients with acute traumatic brain injury often need to be monitored and treated in the intensive care unit,and critically ill patients may require mechanical ventilation to assist ventilation.For some patients who need long-term mechanical ventilation,tracheotomy can not reduce the mortality,but it can help patients go offline,avoid serious complications caused by prolonged tracheal intubation,and shorten the residence time of ICU.At present,there is no clinical consensus on the biggest beneficiary of tracheostomy and the best timing of surgical operation.We retrospectively collected and compared the clinical data of patients with severe traumatic brain injury in the past 6 years,analyzed the risk factors that may be related to early tracheotomy,looked for potential target populations,and predicted the trachea of critically ill patients with tracheal intubation The timing of incision.Methods:1.Retrospectively in our hospital in 2014-2020 years,due to brain injury admission and during hospitalization tracheotomy treatment of patients with medical records,excluded for other emergency situations(heart failure,respiratory failure,status epilepticus,etc.)leading to tracheal incision in the patient.The enrolled patients were divided into early tracheostomy group and late tracheostomy group according to whether the implementation time of tracheostomy was within 7 days.2.The baseline assessment of hospitalization includes the transcript of medical records to a standard structured case report form with medical history and physical examination content,hematological examination and imaging examination;the diagnosis and treatment includes medication,surgery,tracheotomy-related indicators,social Economic content and clinical prognostic indicators.3.When comparing the clinical data of the two groups,single factor analysis was used.Factors with statistically significant differences(p < 0.05)were included in Logistic regression analysis.If p< 0.05,it was considered that there was a significant difference between the two groups.The final screening tracheotomy timing of selected independent predictive factors.4.Apply the ROC curve analysis to obtain the best cut-off value for the continuous independent variable(length of tracheal intubation)in the first regression model,and classify it as the intubation time ? 5 days and < 5 days;Based on clinical experience,the GCS score at admission was classified into ? 8 points and> 8 points,and the statistical significance was analyzed using single factor analysis.Again after two classification of 2 factors with the initial univariate analysis,statistical differences.Three factors into the multivariate Logisitic regression analysis,to obtain a second regression prediction model.Further compare the specificity,sensitivity and percentage of correct classification of the two models to select the prediction model with the best prediction ability.Using three independent predictors with statistical significance in the first regression model,three factors were used to jointly predict the ROC curve during early tracheotomy,and the area under the ROC curve was used to evaluate the predictive ability of the model.Results:1.Baseline comparison between the two groups: a total of 73 subjects were included in this study,including 39 cases in the early tracheostomy group,32 cases in the male,with an average age of 52.0±17.6 years,and 6 deaths;34 cases in the late tracheostomy group,There were 25 males with an average age of 56.0±15.2 years and 2 deaths.Prompt the patient's prognosis(such as the total cost of hospitalization,the total length of hospitalization,NICU time and mortality of the two groups)were not significantly different(p > 0.05).2.Between the two groups of patients with brain surgery(p=0.017),the length of intubation(p<0.001),with hypertension(p=0.029)and the percentage of neutrophils was increased(p=0.016)difference all have statistical significance.Multi-factor analysis and binary classification continuous indicators:The above factors and the Glasgow score at admission were included in the Logistic regression model,the length of intubation(OR 0.49,95% CI 0.33-0.72),the Glasgow score at admission(OR 0.73,95% CI 0.58-0.92),and craniocerebral surgery(OR 12.33,95% CI 2.33-65.13).The three factors are independent predictors of early tracheotomy.The length of tracheal intubation and the GCS score on admission are possible protective factors for early tracheotomy.The specificity,sensitivity and prediction accuracy of this regression model are: 76.5%,89.7% and 83.6% respectively.Plotted continuous variables(tracheal intubation duration)to predict ROC curve during early tracheotomy: AUC=0.78,p<0.0001,cutoff value?5,sensitivity 97.44%,specificity 64.71%;plot combined tracheal intubation duration,ROC curve of craniocerebral surgery,hospital admission GCS score prediction: AUC=0.92,p<0.0001,95% CI.(0.86-0.98).Using single factor analysis,the differences between the two types of tracheal intubation time(?5 days and <5 days)and GCS scores(?8 points and > 8 points)were statistically significant.The p values were: p< 0.001,p=0.006.3.To adjust the associated factor of Multivariate Binary Logistic regression showed Glasgow score(OR=6.26,95% CI 1.15-34.04,p=0.034);binary tracheal intubation length(OR=38.83,95 % CI 7.11-211.96,p< 0.001)and brain surgery(OR=6.86,95% CI 1.40-33.72,p=0.018)remained as early row independent tracheotomy prediction factors.Its specificity,sensitivity and prediction accuracy are: 82.4%,89.7 %,86.3%.Conclusion:1.In patients with severe traumatic brain injury,comprehensive craniocerebral surgery,the GCS score of the patient on admission and the total length of tracheal intubation may be used to predict the timing of early tracheotomy in patients undergoing tracheal intubation.At the time of intubation long joint,brain surgery,GCS score prediction,when compared to a single long predicted intubation tracheotomy opportunity ROC larger area under the curve,a better evaluation of results.It can be used as a theoretical reference for when patients undergoing tracheal intubation in the clinic should undergo tracheotomy.2.The patient should have an earlier assessment of the possibility of early incision after craniocerebral surgery,GCS score ? 8 points,and endotracheal intubation time ? 5 days,combined with other clinical actual factors,take different incision times,and implement individuality chemical medicine may maximize patient benefits.