带气管造口套管的重症监护病房出院至普通病房与死亡率相关：一项前瞻性、多中心倾向评分分析。

Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis.

机构信息

Intensive Care Unit, Hospital Sant Joan de Deu- Fundacio Althaia, Manresa, Spain.

出版信息

Crit Care Med. 2011 Oct;39(10):2240-5. doi: 10.1097/CCM.0b013e3182227533.

DOI:10.1097/CCM.0b013e3182227533

PMID:21670665

Abstract

OBJECTIVE

To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions.

DESIGN

Prospective, observational survey.

SETTING

Thirty-one intensive care units throughout Spain.

PATIENTS

All patients admitted from March 1, 2008 to May 31, 2008.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival.

STATISTICS

Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place. Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3-1.2] (p=.1).

CONCLUSION

In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor.

摘要

目的

在非实验条件下，分析重症监护病房（ICU）出院前拔管对病房生存率的影响。

设计

前瞻性、观察性调查。

地点

西班牙 31 个 ICU。

患者

2008 年 3 月 1 日至 5 月 31 日期间收治的所有患者。

干预措施

无。

测量和主要结果

在 ICU 出院时，我们记录了人口统计学变量、严重程度评分和 ICU 治疗，特别注意气管切开术。在 ICU 出院后，我们记录了 ICU 再入院和医院生存率。

统计学

对病房死亡率进行多变量分析，使用 Cox 比例风险比调整 ICU 拔管的倾向评分。我们纳入了 4132 名患者，其中 1996 名需要机械通气。其中，260 名（13%）进行了气管切开术，59 名（23%）在 ICU 死亡。在 201 名 ICU 气管切开术存活者中，60 名在 ICU 拔管，141 名带管出院至病房。与 ICU 拔管相关的变量（非神经疾病[85% vs. 64%]、血管活性药物[90% vs. 76%]、肠外营养[55% vs. 33%]、急性肾衰竭[37% vs. 23%]和 ICU 出院时预后良好[40% vs. 18%]）被纳入拔管倾向评分模型。拔管和未拔管患者的病房死亡率相似（22% vs. 23%）；然而，在校正倾向评分和萨瓦德尔评分后，气管切开套管的存在与任何生存劣势均无关，优势比为 0.6[0.3-1.2]（p=.1）。