Department of Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA.
Respir Care. 2013 Feb;58(2):257-63. doi: 10.4187/respcare.01714.
Presence of a tracheostomy tube often decreases the patient's ability to communicate and to tolerate oral intake. The initial tracheostomy tube change is often recommended between day 7 and 14 post insertion. Local guidelines permit tracheostomy tube change 5 days after insertion.
We hypothesized that changing tracheostomy tubes before day 7 is associated with earlier use of a speaking valve as well as earlier oral intake, compared to changing tracheostomy tubes after 7 days.
We prospectively enrolled 130 admitted subjects, after tracheostomy placement to a respiratory care unit between July 2008 and May 2010. Subject data were recorded from the electronic medical record. The primary end point was the time from tracheostomy tube placement to tolerating speaking valve. The secondary end point was the time from tracheostomy tube placement to tolerating oral intake. Complications of tracheostomy tube change were recorded.
Thirty-eight subjects had the first tracheostomy tube change before 7 days (early group), and 92 subjects had the first tracheostomy tube change after 7 days (late group). The early group tolerated a speaking valve significantly sooner than the late group (7 d vs 12 d, P = .001). The early group also tolerated oral intake significantly sooner (10 d vs 20 d, P = .04). After change of the tracheostomy tube, the time to tolerating oral feeding was 5.5 days in both groups. There was no significant difference in time to decannulation between the groups. The early group had a shorter respiratory care unit stay (11 d vs 17 d, P = .001) and a shorter hospital stay (P = .05) than the late group. There was no difference in survival. There were no complications associated with tracheostomy tube change.
Tracheostomy tube change before day 7 is associated with earlier ability to tolerate speaking valve and oral intake. In this series, early tracheostomy tube change was not associated with an increased rate of complications.
气管造口管的存在常常降低患者的沟通能力和经口摄入的耐受性。初次气管造口管更换通常建议在插入后 7 至 14 天进行。当地指南允许在插入后 5 天更换气管造口管。
我们假设与在第 7 天后更换气管造口管相比，在第 7 天之前更换气管造口管与更早使用说话阀以及更早开始经口摄入有关。
我们前瞻性地招募了 130 名在 2008 年 7 月至 2010 年 5 月期间入住呼吸治疗病房的气管切开患者。从电子病历中记录患者数据。主要终点是从气管造口管放置到耐受说话阀的时间。次要终点是从气管造口管放置到耐受经口摄入的时间。记录气管造口管更换的并发症。
38 名患者在第 7 天之前进行了第一次气管造口管更换（早期组），92 名患者在第 7 天后进行了第一次气管造口管更换（晚期组）。早期组耐受说话阀的时间明显早于晚期组（7 天 vs 12 天，P =.001）。早期组也更早耐受经口摄入（10 天 vs 20 天，P =.04）。更换气管造口管后，两组经口喂养的耐受时间均为 5.5 天。两组之间在拔管时间上没有显著差异。早期组的呼吸治疗病房停留时间（11 天 vs 17 天，P =.001）和住院时间（P =.05）均短于晚期组。两组之间的生存率没有差异。气管造口管更换无并发症。
第 7 天之前更换气管造口管与更早耐受说话阀和经口摄入有关。在本系列中，早期气管造口管更换与并发症发生率增加无关。
