Barquist Erik S, Amortegui Jose, Hallal Ali, Giannotti Giovanni, Whinney Robb, Alzamel Heythem, MacLeod Jana
Division of Trauma and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, 9380 SW 150th Street, Ste. 100, Miami, FL 33176, USA.
J Trauma. 2006 Jan;60(1):91-7. doi: 10.1097/01.ta.0000196743.37261.3f.
Tracheostomy is a commonly performed procedure in ventilator dependent patients. Many critical care practitioners believe that performing a tracheostomy early in the postinjury period decreases the length of ventilator dependence as well as having other benefits such as better patient tolerance and lower respiratory dead space. We conducted a randomized, prospective, single institution study comparing the length ventilator dependence in critically ill multiple trauma patients who were randomized to two different strategies for performance of a tracheostomy. We hypothesized that earlier tracheostomy would reduce the number of days of mechanical ventilation, frequency of pneumonia and length of intensive care unit (ICU) stay.
Patients were eligible if they were older than 15 years and either a Glasgow Coma Score (GCS) >4 with a negative brain computed tomography (CT) (no anatomic head injury), or a GCS >9 with a positive head CT (known anatomic head injury). Patients who required tracheostomy for facial/neck injuries were excluded. Patients were randomized to an intention to treat strategy of tracheostomy placement before day 8 or after day 28.
The study was halted after the first interim analysis. There were 60 enrolled patients, who had comparable demographics between groups. There was no significant difference between groups in any outcome variable including length of ventilator support, pneumonia rate, or death.
A strategy of tracheostomy before day 8 postinjury in this group of trauma patients did not reduce the number of days of mechanical ventilation, frequency of pneumonia or ICU length of stay as compared with the group with a tracheostomy strategy involving the procedure at 28 days postinjury or more.
气管切开术是依赖呼吸机的患者中常见的操作。许多重症监护从业者认为，在受伤后早期进行气管切开术可缩短呼吸机依赖时间，并具有其他益处，如患者耐受性更好和呼吸道死腔更小。我们进行了一项随机、前瞻性、单机构研究，比较了随机接受两种不同气管切开术策略的重症多发伤患者的呼吸机依赖时间。我们假设早期气管切开术可减少机械通气天数、肺炎发生率和重症监护病房（ICU）住院时间。
年龄大于15岁且格拉斯哥昏迷评分（GCS）>4且头颅计算机断层扫描（CT）阴性（无解剖学头部损伤）或GCS>9且头颅CT阳性（已知解剖学头部损伤）的患者符合入选标准。因面部/颈部损伤需要气管切开术的患者被排除。患者被随机分为意向性治疗策略组，一组在第8天前进行气管切开术，另一组在第28天后进行气管切开术。
第一次中期分析后研究停止。共有60名患者入组，两组患者的人口统计学特征具有可比性。在任何结局变量上，包括呼吸机支持时间、肺炎发生率或死亡率，两组之间均无显著差异。
与在受伤后28天或更晚进行气管切开术的策略组相比，该组创伤患者在受伤后第8天前进行气管切开术的策略并未减少机械通气天数、肺炎发生率或ICU住院时间。
