三级转诊医院内科重症监护病房气管切开时机的决定因素

Factors determining the timing of tracheostomy in medical ICU of a tertiary referral hospital.

作者信息

Park Young Sik, Lee Jinwoo, Lee Sang-Min, Yim Jae-Joon, Kim Young Whan, Han Sung Koo, Yoo Chul-Gyu

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Tuberc Respir Dis (Seoul). 2012 Jun;72(6):481-5. doi: 10.4046/trd.2012.72.6.481. Epub 2012 Jun 29.

DOI:10.4046/trd.2012.72.6.481

PMID:23101014

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3475456/

Abstract

BACKGROUND

Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU).

METHODS

Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study.

RESULTS

Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and PaO(2)/FiO(2)<300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores≥20 (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks.

CONCLUSION

APACHE II scores≥20 and time delay for tracheostomy were associated with tracheostomy after 2 weeks.

摘要

背景

气管切开术是需要长期机械通气患者的常见手术。然而，气管切开术的时机差异很大。本研究旨在找出决定医学重症监护病房（ICU）气管切开术时机的因素。

方法

本回顾性研究纳入了2008年1月至2009年12月在首尔国立大学医院医学ICU接受气管切开术的患者。

结果

59例患者中，36例（61.0%）为男性。入院当天急性生理与慢性健康状况评估（APACHE）II评分和序贯器官衰竭评估评分的中位数分别为28分和7分。气管切开术的决定在气管插管后13天做出，气管切开术在15天进行。59例患者中，21例在2周前接受气管切开术（I组），38例在2周后接受气管切开术（II组）。单因素分析显示，两组在决定进行气管切开术的天数（8天对14.5天，p<0.001）、气管切开术前天数（10天对18天，p<0.001）、气管切开术的时间延迟（2.1天对3.0天，p<0.001）、心肺复苏（19.0%对2.6%，p=0.049）、是否存在神经问题（38.1%对7.9%，p=0.042）、APACHE II评分（24分对30分，p=0.002）以及动脉血氧分压/吸入氧分数<300 mmHg（61.9%对91.1%，p=0.011）方面存在差异。多因素分析显示，APACHE II评分≥20（比值比[OR]，12.44；95%置信区间[CI]，1.14~~136.19；p=0.039）和气管切开术的时间延迟（OR，1.97；95%CI，1.11~~3.55；p=0.020）与2周后气管切开术显著相关。