Department of Emergency, San Gerardo Hospital, Monza, Italy.
Respir Care. 2013 Mar;58(3):482-6. doi: 10.4187/respcare.01889.
The influence of percutaneous tracheostomy on ventilator-dependence and clinical outcomes has been investigated in a number of studies. However, except for the variations during the procedure, the impact of tracheostomy on gas exchange has been scarcely explored. We investigated the effect of tracheostomy on respiratory function in a cohort of ICU patients.
In this retrospective study, clinical records of 107 patients from a general ICU and neurosurgical ICU who underwent percutaneous tracheostomy were reviewed to compare ventilator setting, gas exchange, and hemodynamic parameters on the day before and on the day after the procedure. Further, a pre-established subgroup analysis on hypoxemic patients (Pao2/Fio2 < 300 mm Hg) was performed.
Among all patients analyzed, a marginal decrease in Paco2 (43 ± 9 mm Hg vs 42 ± 7 mm Hg, before vs after P = .004) and an increase in pH (7.43 ± 0.04 vs 7.44 ± 0.03, before vs after P = .03) were observed after tracheostomy. In the subgroup of hypoxemic patients (n = 38), after the tracheostomy an increase in Pao2/Fio2 (222 ± 60 mm Hg vs 256 ± 84 mm Hg, before vs after P = .001) and a decrease in Paco2 (46 ± 11 mm Hg vs 43 ± 9 mm Hg, before vs after P = .001) were found.
Percutaneous tracheostomy did not worsen gas exchange in a cohort of ICU patients. In hypoxemic patients, tracheostomy appeared to improve oxygenation and ventilation.
已有多项研究探讨了经皮气管切开术对呼吸机依赖和临床结局的影响。然而，除了手术过程中的变化外，气管切开术对气体交换的影响尚未得到充分探讨。我们调查了气管切开术对 ICU 患者呼吸功能的影响。
在这项回顾性研究中，我们分析了来自普通 ICU 和神经外科 ICU 的 107 例行经皮气管切开术患者的临床记录，以比较手术前后的呼吸机设置、气体交换和血流动力学参数。此外，我们还对低氧血症患者（Pao2/Fio2<300mmHg）进行了预先设定的亚组分析。
在所有分析的患者中，气管切开术后 PaCO2（43±9mmHg 比 42±7mmHg，P=0.004）略有下降，pH 值（7.43±0.04 比 7.44±0.03，P=0.03）略有升高。在低氧血症患者（n=38）亚组中，气管切开术后 Pao2/Fio2（222±60mmHg 比 256±84mmHg，P=0.001）增加，PaCO2（46±11mmHg 比 43±9mmHg，P=0.001）下降。
在一组 ICU 患者中，经皮气管切开术并未加重气体交换恶化。在低氧血症患者中，气管切开术似乎改善了氧合和通气。
