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BackgroundStudy objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after intensive care unit (ICU) discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach. MethodsThis retrospective cohort study recruited all adult tracheostomy subjects admitted between January 2016 and December 2018. Long-term tracheostomy subjects with recurrent admissions and compromised airway, and subjects with neck tumors obstructing the airway were excluded.Data regarding subjects' demographics, comorbidities, Glasgow Come Score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse, respiratory therapist, speech clinician, Ear, Nose, and Throat (ENT) specialist, and Rehab medicine specialist. ResultsOf the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none of them developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 days. Predictors of long-term tracheostomy were GCS <11 (odds ratio [OR], 5.6; 95% CI, 2.7-12), age ≥65 years

model conditional on the crowding out of tobacco was created using quadratic conditional Engel curves. X2 tests for consumer separability were also performed. Additionally, an analysis of tobacco tax progressivity was completed in order to enhance policy recommendations. Kakwani indices were generated and dominance tests conducted. Findings: Overall, households which consume tobacco spend less on certain commodities compared to households which do not consume tobacco (reduction of expenditure on fruits, vegetables, grains, pulses, education, transportation and fuel are significant at a 5% level). These goods have nutrition and family welfare implications. Generally, trends are more pronounced in urban settings. Also, poorer quintiles tended to spend a greater proportion of their budget on tobacco (3.6% poorest quintile, 2.7% richest quintile). X2 tests led to rejection of the separability between tobacco and most other goods, meaning that tobacco consumers have different preferences and behave differently than non-tobacco consumers.The preliminary conditional demand model confirms many of the trends in the descriptive statistics, namely that vegetable and education spending shares are adversely impacted by tobacco consumption. Initial analysis demonstrates that tobacco taxation is progressive, highlighting potential equity implications to increases of tobacco taxation. Interpretation: There is evidence to suggest that tobacco spending crowds-out the consumption of goods, such as vegetables and education. In particular, poor households and those living in urban areas are most vulnerable. Key policy implications arise regarding the importance of tobacco control measures, such as taxation. Funding: None.

Background There are no national data regarding outcomes of tracheostomy patients. The aim of this study was to examine the outcomes of tracheostomy inpatients at KAMC-Jeddah using an interdisciplinary care model. The objectives were to identify the proportion of tracheostomy patients with successful decannulation, estimate the time to decannulation post intensive care unit (ICU) discharge, and to identify the predictors of weaning trials failure. Methods This study had a retrospective cohort design in which all tracheostomy patients from January 2016 until December 2018 were included. Pediatric patients and those with neck tumors obstructing the airway were excluded. Data regarding patients' demographics, comorbidities, GCS, and ICU discharge and decannulation dates were collected. Tracheostomy patients were assessed weekly during team rounds by all team members (respiratory therapist, speech clinician, ENT doctor, rehab medicine doctor, tracheostomy resource nurse). Results The cohort included 221 patients, of whom 36 were chronic tracheostomy patients. Of the 185 patients who underwent weaning trials, 71 (38%) were successfully weaned and decannulated; the median time to decannulation post ICU discharge was 46.5 days. Predictors of weaning trials failure were number of comorbidities (odd ratio [OR] 2.635, 95% CI 1.4-5.0, p<0.01), GCS score <11 (OR 6, 95% CI 2.7-13.9, p<0.01), female sex (OR 3.1, 95% CI 1.3-7.5, p<0.01), and age (OR 1.04, 95% CI 1.02-1.06, p<0.01). All decannulation attempts were safe and successful, and none of the 40 inpatient deaths (18%) were related to tracheostomy. Conclusion The majority of tracheostomy patients had prolonged hospital stay. The interdisciplinary care model ensured the safety of their weaning/decannulation process and improved the quality of their hospital care.