26% in the tracheostomy group and 26.32% in the translaryngeal tube-intubated patients). This may underlie the increased requirement for hemodialysis in this group of patients and explain the lack of an increase in mortality (patients in Chao’s study had more severe selleck chem Ponatinib renal dysfunction) .Our study has a number of limitations that warrant mention. First, it should be noted that all tracheostomy patients received traditional surgical tracheostomies. Others have suggested that the popularity of the percutaneous tracheostomy technique is a major reason underlying the increased utilization of tracheostomy in PMV patients . Hence in our analysis, we were not able to compare outcome with regard to tracheotomy technique (that is, percutaneous versus traditional surgical tracheostomy).
Conversely, the homogeneity of our tracheostomy patient cohort in this respect could be viewed as a positive in terms of a decreased risk of technique-associated confounding. A further limitation is that we did not record data concerning decannulation of the tracheostomy, the effects of inadvertent extubation on the outcomes of the translaryngeally intubated group, tracheostomy complications, or the rate of ventilator-associated pneumonia in the different groups. Any of these factors could have influenced patient morbidity, mortality, or weaning ability.Third, we did not assess the outcomes of patients after discharge. The long-term benefits (if any) of tracheostomy compared with translaryngeal intubation are yet to be determined.Finally, our patients were not randomly assigned to the tracheostomy or translaryngeal-intubation groups.
Although we used a case-matched method of statistical analysis, our data are confounded by the subjective decisions of the attending physicians to initiate tracheostomy. We also acknowledge that despite our best efforts to control for confounding factors, residual confounders associated with the different patient populations may have influenced our findings.ConclusionsWithin a specialized respiratory care unit, successful weaning was not increased in tracheostomy compared with translaryngeally intubated patients. No between-group differences were found in RCC or in-hospital mortality, as determined by case-match analysis. Interestingly, tracheostomy was found to be a significant predictor of survival. These findings suggest that focused care administered by experienced Cilengitide providers, as occurs in a specialized care unit, is more important in facilitating weaning than is the ventilation method used. In our weaning and survival regression model, the subgroup of patients who exhibited the most-positive outcomes had lower BUN levels, higher albumin concentrations, moderate APACHE II scores, and tracheostomies.