Papuzinski et al developed a multivariate model for predicting if a patient admitted to the intensive care unit (ICU) would need a tracheostomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Universidad de Valparaiso and Hospital Naval Almirante Nef in Chile.
Patient selection: adult admitted to ICU who has been intubated
Outcome: prolonged intubation (orotracheal intubation >= 7 days), indicating a patient who may benefit from early tracheostomy
Parameters:
(1) age in years (divided into tertiles)
(2) PaO2 to FiO2 ratio on intubation day
(3) serum sodium concentration on intubation day
(4) COPD
Parameter |
Finding |
Points |
age |
< 65 years old |
1 |
|
65 to 76 years |
2 |
|
>= 77 years |
3 |
PaO2 ratio |
>= 200 |
0 |
|
< 200 |
1 |
serum sodium |
hypernatremia |
1 |
|
other |
0 |
COPD |
absent |
0 |
|
present |
1 |
where:
• The adjusted odds ratios were 1.97 for age (per tertile), 3.9 for hypernatremia, 3 for COPD and 2.6 for PaO2 to FIO2 ratio.
X =
= (0.68 * (points for age)) + (0.97 * (points for PaO2 to FIO2 raio)) + (1.35 * (points for serum sodium)) + (1.1 * (points for COPD)) – 2.8
probability of requiring a tracheostomy =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.81.
Specialty: Pulmonology