Schmidt Ulrich, Hess Dean, Kwo Jean, Lagambina Susan, Gettings Elise, Khandwala Farah, Bigatello Luca M, Stelfox Henry Thomas
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA.
Respiratory Care, Massachusetts General Hospital, Boston, MA.
Chest. 2008 Aug;134(2):288-294. doi: 10.1378/chest.07-3011. Epub 2008 Apr 10.
Tracheostomy tube malposition is a barrier to weaning from mechanical ventilation. We determined the incidence of tracheostomy tube malposition, identified the associated risk factors, and examined the effect of malposition on clinical outcomes.
We performed a retrospective study on 403 consecutive patients with a tracheostomy who had been admitted to an acute care unit specializing in weaning from mechanical ventilation between July 1, 2002, and December 31, 2005. Bronchoscopy reports were reviewed for evidence of tracheostomy tube malposition (ie, > 50% occlusion of lumen by tissue). The main outcome parameters were the incidence of tracheostomy tube malposition; demographic, clinical, and tracheostomy-related factors associated with malposition; clinical response to correct the malposition; the duration of mechanical ventilation; the length of hospital stay; and mortality.
Malpositioned tracheostomy tubes were identified in 40 of 403 patients (10%). The subspecialty of the surgical service physicians who performed the tracheostomy was most strongly associated with malposition. Thoracic and general surgeons were equally likely to have their patients associated with a malpositioned tracheostomy tube, while other subspecialty surgeons were more likely (odds ratio, 6.42; 95% confidence interval, 1.82 to 22.68; p = 0.004). Malpositioned tracheostomy tubes were changed in 80% of cases. Malposition was associated with prolonged mechanical ventilation posttracheostomy (median duration, 25 vs 15 d; p = 0.009), but not with increased hospital length of stay or mortality.
Tracheostomy tube malposition appears to be a common and important complication in patients who are being weaned from mechanical ventilation. Surgical expertise may be an important factor that impacts this complication.
气管造口管位置异常是机械通气撤机的一个障碍。我们确定了气管造口管位置异常的发生率，识别了相关危险因素，并研究了位置异常对临床结局的影响。
我们对2002年7月1日至2005年12月31日期间入住一家专门进行机械通气撤机的急性护理单元的403例连续气管造口患者进行了一项回顾性研究。查阅支气管镜检查报告以寻找气管造口管位置异常的证据（即管腔被组织堵塞>50%）。主要结局参数包括气管造口管位置异常的发生率；与位置异常相关的人口统计学、临床和气管造口相关因素；纠正位置异常后的临床反应；机械通气时间；住院时间；以及死亡率。
403例患者中有40例（10%）气管造口管位置异常。进行气管造口术的外科服务医师的亚专业与位置异常关联最为密切。胸外科和普通外科医师使患者发生气管造口管位置异常的可能性相同，而其他亚专业外科医师使患者发生位置异常的可能性更大（比值比为6.42；95%置信区间为1.82至22.68；p = 0.004）。80%的病例更换了位置异常的气管造口管。位置异常与气管造口术后机械通气时间延长相关（中位时间分别为25天和15天；p = 0.009），但与住院时间延长或死亡率增加无关。
气管造口管位置异常似乎是机械通气撤机患者中常见且重要的并发症。手术专业知识可能是影响这一并发症的一个重要因素。
