Development and validation of a nomogram for tracheotomy decannulation in individuals in a persistent vegetative state: A multicentre study.

Autor: Zeng H; School of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou City, Henan Province 450000, China., Zeng X; Department of Rehabilitation Medicine III, The First Affiliated Hospital of Zhengzhou University, No.169-10 Nanyang Road, Zhengzhou City, Henan Province 450000, China; The NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, No.1 Jianshe East Road, Zhengzhou City, Henan Province 450000, China. Electronic address: bestzhj@gs.zzu.edu.cn., Liu N; Sanquan College, No. 688, East Section of Shixiangyang Road, Xinxiang City, Henan Province 453000, China., Ding Y; Department of Neurology, The Second Medical Center, PLA General Hospital, No. 28 Fuxing Road, Beijing City 100000, China., Wu J; Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 433 Huashan Road, Shanghai City 200000, China., Zhang F; Department of Rehabilitation Medicine, Xinyang Central Hospital, No.1 Siyi Road, Xinyang City, Henan Province 464000, China., Xiong N; Peking University Sixth Hospital, No. 51 Huayuan North Road, Beijing City 101499, China.
Jazyk: angličtina
Zdroj: Annals of physical and rehabilitation medicine [Ann Phys Rehabil Med] 2024 Sep; Vol. 67 (6), pp. 101849. Date of Electronic Publication: 2024 Jun 02.
DOI: 10.1016/j.rehab.2024.101849
Abstrakt: 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.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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