Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea.
J Neurosurg Anesthesiol. 2014 Jan;26(1):22-6. doi: 10.1097/ANA.0b013e31829770a0.
The optimal timing of tracheostomy in neurosurgical patients is not well established. This retrospective study was conducted to determine the effect of the timing of tracheostomy on clinical outcome in mechanically ventilated neurosurgical patients admitted to the surgical intensive care unit (ICU).
A total of 125 neurosurgical patients, who underwent tracheostomy and had total mechanical ventilation (MV) duration of ≥7 days from October 2007 to December 2011, were enrolled. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 10 days of MV in the early group (group E, n=39), whereas in the late group, it was performed after 10 days of MV (group L, n=86). The ICU and in-hospital mortality rates, total duration of MV, length of stay (LOS) in the ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between both the groups.
The total MV duration and ICU LOS were significantly longer in group L than E (21.5±15.5 vs. 11.4±5.6 d, P<0.001; 31.1±18.2 vs. 19.9±10.6 d, P<0.001). The incidence of VAP before tracheostomy was higher in group L than group E (44 vs. 23%, P<0.05). No significant difference was found in the ICU and in-hospital mortality rates and hospital LOS between the groups.
Early tracheostomy reduced the MV duration, ICU LOS, and incidence of VAP in critically ill neurosurgical patients. However, early tracheostomy did not reduce either the ICU or hospital mortality.
神经外科患者行气管切开术的最佳时机尚未明确。本回顾性研究旨在确定机械通气的神经外科患者入住外科重症监护病房（ICU）时行气管切开术的时机对临床转归的影响。
共纳入 125 例行气管切开术且机械通气（MV）时间≥7 天的神经外科患者，这些患者于 2007 年 10 月至 2011 年 12 月入住 ICU。根据气管切开术的时机将患者分为 2 组。MV 后 10 天内行气管切开术的患者归入早期组（E 组，n=39），而 MV 后 10 天内行气管切开术的患者归入晚期组（L 组，n=86）。比较两组患者的 ICU 病死率、院内病死率、MV 总时间、ICU 住院时间、总住院时间和呼吸机相关性肺炎（VAP）发生率。
L 组的 MV 总时间和 ICU 住院时间长于 E 组（21.5±15.5 比 11.4±5.6 d，P<0.001；31.1±18.2 比 19.9±10.6 d，P<0.001）。L 组在气管切开术前 VAP 的发生率高于 E 组（44 比 23%，P<0.05）。两组患者的 ICU 病死率、院内病死率和总住院时间差异无统计学意义。
对危重症神经外科患者行早期气管切开术可减少 MV 时间、ICU 住院时间和 VAP 的发生率。但早期气管切开术并未降低 ICU 或医院病死率。
