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  • Poster presentation
  • Open Access

Early tracheostomy in acute lung injury: who could benefit?

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Critical Care200610 (Suppl 1) :P55

  • Published:


  • Public Health
  • Logistic Regression
  • Mechanical Ventilation
  • Emergency Medicine
  • Lung Injury


Early tracheostomy has been associated with improved outcome in patients with high likelihood of death or ventilator dependency. While a significant number of patients with acute lung injury (ALI) require prolonged mechanical ventilation and could potentially benefit from early tracheostomy, lack of an accurate prediction limits its utilization in this group of patients.


From the database of the second international study of mechanical ventilation we selected patients with ALI who were alive and invasively ventilated on the third day post intubation. From a broad range of risk factors prospectively collected during the first 3 days of mechanical ventilation, univariate and multivariate logistic regression identified variables associated with increased risk of death or ventilator dependency.


From 372 patients meeting inclusion criteria, 281 reached a composite outcome of either death or ventilator dependency of more than 2 weeks. One hundred and ninety-nine (53%) died in the ICU, 104 (28%) were ventilated >14 days and 76 (20%) underwent tracheostomy, median 12 (IQR 8–18) days after the intubation. A score based on age and day 3 values of oxygenation index, VE 40 (minute ventilation needed to bring PaCO2 to 40 mmHg) and shock predicted death or ventilator dependency better (area under receiver operating characteristic curve [AUC] 0.71) than SAPS II (AUC 0.51) or day 3 SOFA (AUC 0.54) scores.


If confirmed in an independent sample, this score may be a useful tool to identify patients with ALI who might benefit from early tracheostomy.

Authors’ Affiliations

Mayo Clinic, Rochester, MN, USA
Hospital Universitario de Getafe, Madrid, Spain
University of Texas Health Science Center, San Antonio, TX, USA
University of Toronto, Canada
Hospital Profesor Posadas, Buenos Aires, Argentina
King Abdulaziz Medical City, Riyadh, Saudi Arabia
Wythenshawe Hospital, Manchester, UK
Ospedale Policlinico, Milan, Italy
Medical Center Leeuwarden, The Netherlands
Hôpital Henri Mondor, Creteil, France
Medical School of Hannover, Germany


© BioMed Central Ltd 2006