Ventilation Weaning Strategies and Correlation to Outcomes in Tracheostomized Patients in the Lausanne ICU

Study Overview
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Brief Summary
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This retrospective study aims to study characteristics of patients tracheotomized in the Lausanne ICU, both overall and by primary reasons of intubation. Ventilation data both before and after tracheotomy, weaning technique and timing are studied in this retrospective study.

Official Title
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Analysis of Ventilation Weaning Strategies and Correlation to Outcomes in Tracheostomized Patients in the Intensive Care Unit of the Lausanne University Hospital

Conditions
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Respiratory Failure, Tracheostomy Complication

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients hospitalized in the Lausanne ICU between May 1st 2017 and November 31st 2018 with a tracheotomy and mechanically ventilated more than 72 hours. Exclusion Criteria: Presence of a know opposition to participation to research projects Patient tracheostomized specifically for ENT (ear-nose-throat) reason Burn victim Patient tracheostomized before his/her admission to the Lausanne ICU

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Intubation for respiratory reasons<br>All patients who were intubated for respiratory reasons (i.e. acute respiratory distress syndrome, pneumonias, pleural effusions for example) | |
| Intubation for neurological reasons<br>All patients who were intubated for neurological reasons (i.e. stroke, intracranial bleeding, cervical fracture with tetraparesia for example) | |
| Intubation for other reasons<br>All patients who were intubated for other reasons than respiratory or neurological (i.e. intubation before surgery, cardiac arrest, hemodynamic instability and polytraumatism without respiratory distress or neurological pathology necessitating intubation) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time from intubation to tracheotomy | Calculated from clinical information system (time of intubation, time of tracheotomy), calculated in hours | Once, between time of intubation to time of tracheotomy, up to 60 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Age | Collected from electronic patient files. | At ICU admission | 
| Weight | Collected from electronic patient files. | At ICU admission | 
| Height | Collected from electronic patient files. | At ICU admission | 
| Body mass index | Calculated from weight and height | At ICU admission | 
| Predicted body weight (PBW) | Calculated as such : Adult male: 50 + 0.91 (Height cm -152.4) / Adult female: 45 + 0.91 (Height cm -152.4) | At ICU admission | 
| SOFA score (admission) | Calculated at admission | At ICU admission | 
| Clinical Frailty Score | Calculated at ICU admission | At ICU admission | 
| Charlson comorbidity index | Calculated at ICU admission | At ICU admission | 
| Comorbidities | Collected at ICU admission | At ICU admission | 
| Ventilation modalities and settings from intubation to tracheotomy | Ventilation modalities and settings recolted from electronic patient files. | Once every day at 8am, between day after intubation to day before tracheotomy, up to 60 days | 
| Sedation opioid use from intubation to tracheotomy | Sedation use collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, between day of intubation to day of tracheotomy, up to 60 days | 
| Opioid use from intubation to tracheotomy | Opioid use collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, between day of intubation to day of tracheotomy, up to 60 days | 
| Neuromuscular blocking agent use from intubation to tracheotomy | Neuromuscular blocking agent use collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, between day of intubation to day of tracheotomy, up to 60 days | 
| Tracheotomy time | Collected from electronic patient files (day and hour) | At time of tracheotomy, once, up to 60 days after intubation day | 
| Tracheotomy type (percutaneous, surgical) | Collected from electronic patient files. | At time of tracheotomy, once, up to 60 days after intubation day | 
| Ventilation settings and modalities from day of tracheotomy | Collected from electronic patient files. | 2 hours before tracheotomy | 
| SOFA score (tracheotomy day) | Calculated from electronic patient files. | Once, on the day of tracheotomy (worst value of the day of tracheotomy), up to 60 days after intubation day | 
| Ventilation modalities and settings from tracheotomy to mechanical ventilation weaning | Ventilation modalities and settings collected from electronic patient files. | Once per day, from day of tracheotomy to mechanical ventilation weaning, up to 60 days | 
| Tracheotomy weaning strategies from tracheotomy to mechanical ventilation weaning | Data collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, from day of tracheotomy to day of mechanical ventilation weaning, up to 31 days | 
| Physical therapy sessions from tracheotomy to mechanical ventilation weaning | Data collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, from day of tracheotomy to day of mechanical ventilation weaning, up to 31 days | 
| Mechanical ventilation weaning day | Data collected from electronic patient files. | Once (day 3 in a row of less than 12 hours of mechanical ventilation), up to 31 days after tracheotomy day | 
| SOFA score (mechanical ventilation weaning day) | Calcutated from electronic patient files. | Once (3rd consecutive day with less than 12-h of mechanical ventilation), up to 31 days after tracheotomy day | 
| Ventilation modalities and settings from mechanical ventilation weaning day to decannulation or ICU discharge or death | Collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, from day of mechanical ventilation weaning to decannulation or ICU discharge or death, up to 31 days | 
| Physical therapy sessions from mechanical ventilation weaning day to decannulation or ICU discharge or death | Collected from electronic patient files. | Once every day at 8am and at time of minimal and maximal value, from day of mechanical ventilation weaning to decannulation or ICU discharge or death, up to 31 days | 
| Hospital stay duration | Collected from electronic patient files and discharge letters | Once, between day of hospital admission to day of hospital discharge, up to 2 years | 
| Outcome and specific treatments in ICU | Data recolted from electronic patient files | Once, between day of hospital admission to day of hospital discharge, up to 2 years | 
| Correlation of ventilation settings and modalities and tracheotomy weaning strategies | Collected from electronic patient files and discharge letters | Once, between day of hospital admission to day of hospital discharge, up to 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Tracheostomy, Ventilation weaning, spontaneous breathing trial