Kollef et al identified factors which may predict if a patient in the intensive care unit (ICU) will require tracheostomy. These can help to identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from Barnes-Jewish Hospital in St. Louis.


Patient selection: Patient in the ICU who has required mechanical ventilation for > 12 hours


Predictors identified on multivariate analysis:

(1) presence of nosocomial pneumonia

(2) therapy with an aerosolized medicine

(3) witnessed aspiration event

(4) requires reintubation (after extubation)


The chances of being intubated increases with the number of these factors that are present.


Additional factors associated with a need for tracheostomy:

(1) presence of COPD

(2) undergoing fiberoptic bronchoscopy


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