Zagli Giovanni, Linden Manuel, Spina Rosario, Bonizzoli Manuela, Cianchi Giovanni, Anichini Valentina, Matano Stefania, Benemei Silvia, Nicoletti Paola, Peris Adriano
Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, and Clinical Pharmacology and Clinical Research Unit, Florence, Italy.
J Trauma. 2010 Feb;68(2):367-72. doi: 10.1097/TA.0b013e3181a601b3.
Percutaneous dilatational tracheostomy (PDT) is a common procedure in critically ill patients, but the correct timing is still controversial. This study was designed to establish whether an early timing in video-guided Ciaglia Blue Rhino PDT affects the duration of mechanical ventilation (MV) and the length of stay (LOS) in intensive care unit (ICU). Secondary clinical outcomes were the overall hospitalization duration and the mortality rate.
A retrospective, single-center study of 2,210 patients admitted to the ICU of the Emergency Department of the Careggi Teaching Hospital (Florence, Italy) between 2002 and 2007. Among the 506 patients who underwent PDT, 256 and 250 patients were retrospectively assigned to the early tracheostomy (ET) or late tracheostomy (LT) group according to whether the procedure was performed before (ET) or after (LT) 3 days of MV (median time of procedure execution).
The two groups of patients showed comparable demographic and clinical characteristics. The video-guided PDT procedures were performed without major complications in all cases. The average timing of tracheostomy in the ET group was 1.9 +/- 0.9 days, whereas in LT group resulted 6.8 +/- 3.8 days (mean +/- SD). Total hospital LOS and mortality rate were not different between the two groups. However, the duration of MV days and of ICU LOS group were significantly shorter in the ET group (13.3 +/- 9.6 and 16.9 +/- 13.0 days, respectively; p = 0.0001) than in the LT group (16.7 +/- 8.3 days and 20.8 +/- 9.2 days, respectively; p < 0.0001). Stratified analysis by the three major ICU admission diagnosis confirmed that both traumatized and nontraumatized (medical and postsurgical) ET patients had a shorter MV duration and ICU LOS as compared with LT patients.
Video-guided Ciaglia Blue Rhino PDT is safe and easy to perform in ICU. No difference in overall hospital LOS, incidence of pneumonia, and mortality rate between the ET and LT groups was found. However, in both traumatized and nontraumatized patients, shortened duration of ICU LOS and MV in the ET group (<or=3 days) indicates this procedure as a useful approach for patients and healthcare system.
经皮扩张气管切开术（PDT）是危重症患者的常见操作，但正确的时机仍存在争议。本研究旨在确定视频引导下Ciaglia Blue Rhino PDT的早期时机是否会影响机械通气（MV）的持续时间和重症监护病房（ICU）的住院时间（LOS）。次要临床结局为总住院时间和死亡率。
对2002年至2007年间入住佛罗伦萨卡雷吉教学医院急诊科ICU的2210例患者进行回顾性单中心研究。在506例行PDT的患者中，根据手术是在MV 3天之前（早期气管切开术，ET）还是之后（晚期气管切开术，LT）进行（手术执行的中位时间），将256例和250例患者回顾性地分为早期气管切开术组或晚期气管切开术组。
两组患者的人口统计学和临床特征具有可比性。所有病例的视频引导下PDT操作均无重大并发症。ET组气管切开术的平均时机为1.9±0.9天，而LT组为6.8±3.8天（均值±标准差）。两组的总住院LOS和死亡率无差异。然而，ET组的MV天数和ICU LOS组明显短于LT组（分别为13.3±9.6天和16.9±13.0天；p = 0.0001），LT组分别为16.7±8.3天和20.8±9.2天；p < 0.0001）。通过三种主要的ICU入院诊断进行分层分析证实，与LT患者相比，创伤性和非创伤性（内科和外科术后）ET患者的MV持续时间和ICU LOS均较短。
视频引导下Ciaglia Blue Rhino PDT在ICU中安全且易于实施。ET组和LT组在总住院LOS、肺炎发生率和死亡率方面未发现差异。然而，在创伤性和非创伤性患者中，ET组（≤3天）ICU LOS和MV持续时间缩短表明该操作对患者和医疗系统是一种有用的方法。
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