Development and validation of a nomogram for tracheotomy decannulation in individuals in a persistent vegetative state: A multicentre study.
Ann Phys Rehabil Med
; 67(6): 101849, 2024 Sep.
Article
em En
| MEDLINE
| ID: mdl-38830320
ABSTRACT
BACKGROUND:
Decannulation for people in a persistent vegetative state (PVS) is challenging and relevant predictors of successful decannulation have yet to be identified.OBJECTIVE:
This study aimed to explore the predictors of tracheostomy decannulation outcomes in individuals in PVS and to develop a nomogram.METHOD:
In 2022, 872 people with tracheostomy in PVS were retrospectively enrolled and their data was randomly divided into a training set and a validation set in a 73 ratio. Univariate and multivariate regression analyses were performed on the training set to explore the influencing factors for decannulation and nomogram development. Internal validation was performed using 5-fold cross-validation. External validation was performed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) on both the training and validation sets.RESULT:
Data from 610 to 262 individuals were used for the training and validation sets, respectively. The multivariate regression analysis found that duration of tracheostomy tube placement≥30 days (Odds Ratio [OR] 0.216, 95â¯% CI 0.151-0.310), pulmonary infection (OR 0.528, 95â¯%CI 0.366-0.761), hypoproteinemia (OR 0.669, 95â¯% CI 0.463-0.967), no passive standing training (OR 0.372, 95â¯% CI 0.253-0.547), abnormal swallowing reflex (OR 0.276, 95â¯% CI 0.116-0.656), mechanical ventilation (OR 0.658, 95â¯% CI 0.461-0.940), intensive care unit (ICU) duration>4 weeks (OR 0.517, 95â¯% CI 0.332-0.805), duration of endotracheal tube (OR 0.855, 95â¯% CI 0.803-0.907), older age (OR 0.981, 95â¯% CI 0.966-0.996) were risk factors for decannulation failure. Conversely, peroral feeding (OR 1.684, 95â¯% CI 1.178-2.406), passive standing training≥60â¯min (OR 1.687, 95â¯% CI 1.072-2.656), private caregiver (OR 1.944, 95â¯% CI 1.350-2.799) and ICU duration<2 weeks (OR 1.758, 95â¯% CI 1.173-2.634) were protective factors conducive to successful decannulation. The 5-fold cross-validation revealed a mean area under the curve of 0.744. The ROC curve C-indexes for the training and validation sets were 0.784 and 0.768, respectively, and the model exhibited good stability and accuracy. The DCA revealed a net benefit when the risk threshold was between 0 and 0.4.CONCLUSION:
The nomogram can help adjust the treatment and reduce decannulation failure. REGISTRATION Clinical registration is not mandatory for retrospective studies.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Traqueostomia
/
Estado Vegetativo Persistente
/
Nomogramas
Limite:
Adult
/
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Ann Phys Rehabil Med
Assunto da revista:
MEDICINA FISICA
/
REABILITACAO
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
China