Rodriguez J L, Steinberg S M, Luchetti F A, Gibbons K J, Taheri P A, Flint L M
Department of Surgery, State University of New York, Buffalo.
Surgery. 1990 Oct;108(4):655-9.
During a 12-month period, 264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit. One hundred twenty patients (46%) were disengaged from the ventilator, and 38 patients (14%) died. Of the remaining 106 patients (40%) 51 patients (group I) were to receive tracheostomy within 1 to 7 days, and 55 patients (group II) underwent late (8 or more days after admission) tracheostomy. Multiple variables in four categories (admission, operative, ventilatory, and outcome) were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were assessed. Early tracheostomy, in a homogeneous group of critically ill patients, is associated with a significant decrease in duration of mechanical ventilation, as well as shorter intensive care unit and hospital stays, compared with translaryngeal endotracheal intubation. There were no deaths attributable to tracheostomy, and overall morbidity of the procedures was 4%. We conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation. Furthermore, early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation.
在12个月的期间内，264例需要机械通气的多发伤患者被收入外科重症监护病房。120例患者（46%）撤机，38例患者（14%）死亡。其余106例患者（40%）中，51例患者（I组）在1至7天内接受气管切开术，55例患者（II组）接受延迟（入院8天或更晚）气管切开术。前瞻性分析了四个类别（入院、手术、通气和结局）中的多个变量，以确定早期气管切开术对机械通气时间、重症监护病房停留时间和住院时间的影响。评估了手术的发病率和死亡率。与经喉气管插管相比，在一组病情严重程度相似的重症患者中，早期气管切开术与机械通气时间显著缩短以及重症监护病房和住院时间缩短相关。没有因气管切开术导致的死亡，手术的总体发病率为4%。我们得出结论，早期气管切开术的总体风险与气管插管相当。此外，早期气管切开术可缩短通气天数、重症监护病房天数和住院天数，对于预计插管超过7天的重症监护病房患者应考虑采用。
