Development and validation of a nomogram for tracheotomy decannulation in individuals in a persistent vegetative state: A multicentre study - 14/08/24
, Nanxi Liu d, Yu Ding e, Junfa Wu f, Fangquan Zhang g, Nana Xiong h
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Highlights |
• | Study of 872 individuals with tracheostomy in persistent vegetative state. |
• | Ten factors found to be associated with successful decannulation. |
• | Innovative variables like passive standing training included in the model. |
• | The nonogram has internal and external validity. |
• | Use of the nonogram could improve decannulation success. |
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 7:3 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, 95 % CI 0.151–0.310), pulmonary infection (OR 0.528, 95 %CI 0.366–0.761), hypoproteinemia (OR 0.669, 95 % CI 0.463–0.967), no passive standing training (OR 0.372, 95 % CI 0.253–0.547), abnormal swallowing reflex (OR 0.276, 95 % CI 0.116–0.656), mechanical ventilation (OR 0.658, 95 % CI 0.461–0.940), intensive care unit (ICU) duration>4 weeks (OR 0.517, 95 % CI 0.332–0.805), duration of endotracheal tube (OR 0.855, 95 % CI 0.803–0.907), older age (OR 0.981, 95 % CI 0.966–0.996) were risk factors for decannulation failure. Conversely, peroral feeding (OR 1.684, 95 % CI 1.178–2.406), passive standing training≥60 min (OR 1.687, 95 % CI 1.072–2.656), private caregiver (OR 1.944, 95 % CI 1.350–2.799) and ICU duration<2 weeks (OR 1.758, 95 % 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.
Le texte complet de cet article est disponible en PDF.Keywords : Persistent vegetative state, Tracheostomy, Decannulation, Rehabilitation, Intermittent oro-esophageal tube feeding
Abbreviations : DCA, ICU, IOE, OR, PVS, ROC
Plan
Vol 67 - N° 6
Article 101849- septembre 2024 Retour au numéro
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