Development and validation of a nomogram for tracheotomy decannulation in individuals in a persistent vegetative...

Area of Science:

• Medical Research
• Clinical Medicine
• Rehabilitation

Background:

• Decannulation in persistent vegetative state (PVS) patients presents significant challenges.
• Identifying predictors for successful decannulation in this population is critical.

Purpose of the Study:

• To identify predictors of tracheostomy decannulation outcomes in individuals with PVS.
• To develop a predictive nomogram for decannulation success in PVS patients.

Main Methods:

• Retrospective enrollment of 872 tracheostomized PVS patients.
• Data split into training (70%) and validation (30%) sets.
• Multivariate regression, 5-fold cross-validation, ROC curves, and DCA for model validation.

Main Results:

• Identified risk factors for decannulation failure: prolonged tracheostomy, pulmonary infection, hypoproteinemia, lack of standing training, abnormal swallowing reflex, mechanical ventilation, extended ICU stay, and older age.
• Identified protective factors: peroral feeding, sufficient standing training, private caregiver, and shorter ICU duration.
• The developed nomogram demonstrated good predictive accuracy (AUC 0.744, C-indexes 0.784/0.768).

Conclusions:

• A validated nomogram can assist clinicians in tailoring treatment strategies.
• The nomogram aims to improve patient outcomes by reducing decannulation failure rates.