Dunham C Michael, Cutrona Anthony F, Gruber Brian S, Calderon Javier E, Ransom Kenneth J, Flowers Laurie L
Trauma/Critical Care Services, St. Elizabeth Health Center 1044 Belmont Avenue, Youngstown, OH, 44501, USA.
Infection Control Services, St. Elizabeth Health Center 1044 Belmont Avenue, Youngstown, OH, 44501, USA.
Int J Burns Trauma. 2014 Feb 22;4(1):14-24. eCollection 2014.
In the past, the authors performed a comprehensive literature review to identify all randomized controlled trials assessing the impact of early tracheostomy on severe brain injury outcomes. The search produced only two trials, one by Sugerman and another by Bouderka.
The current authors initiated an Institutional Review Board-approved severe brain injury randomized trial to evaluate the impact of early tracheostomy on ventilator-associated pneumonia rates, intensive care unit (ICU)/ventilator days, and hospital mortality. Current study results were compared with the other randomized trials and a meta-analysis was performed.
Early tracheostomy pneumonia rates were Sugerman-48.6%, Bouderka-58.1%, and current study-46.7%. No early tracheostomy pneumonia rates were Sugerman-53.1%, Bouderka-61.3%, and current study-44.4%. Pneumonia rate meta-analysis showed no difference for early tracheostomy and no early tracheostomy (OR 0.89; p = 0.71). Early tracheostomy ICU/ventilator days were Sugerman-16 ± 5.9, Bouderka-14.5 ± 7.3, and current study-14.1 ± 5.7. No early tracheostomy ICU/ventilator days were Sugerman-19 ± 11.3, Bouderka-17.5 ± 10.6, and current study-17 ± 5.4. ICU/ventilator day meta-analysis showed 2.9 fewer days with early tracheostomy (p = 0.02). Early tracheostomy mortality rates were Sugerman-14.3%, Bouderka-38.7%, and current study-0%. No early tracheostomy mortality rates were Sugerman-3.2%, Bouderka-22.6%, and current study-0%. Randomized trial mortality rate meta-analysis showed a higher rate for early tracheostomy (OR 2.68; p = 0.05). Because the randomized trials were small, a literature assessment was undertaken to find all retrospective studies describing the association of early tracheostomy on severe brain injury hospital mortality. The review produced five retrospective studies, with a total of 3,356 patients. Retrospective study mortality rate meta-analysis demonstrated a larger mortality for early tracheostomy (OR 1.97; p < 0.0001).
For severe brain injury, analyses indicate that ventilator-associated pneumonia rates are not decreased with early tracheostomy. Further, this study implies that mechanical ventilation is reduced with early tracheostomy. Both the randomized trial and retrospective meta-analysis indicate that risk for hospital death increases with early tracheostomy. Findings imply that early tracheostomy for severe brain injury is not a prudent routine policy.
过去，作者进行了一项全面的文献综述，以确定所有评估早期气管切开术对严重脑损伤结局影响的随机对照试验。检索仅产生了两项试验，一项由苏格曼进行，另一项由布德卡进行。
当前作者启动了一项经机构审查委员会批准的严重脑损伤随机试验，以评估早期气管切开术对呼吸机相关性肺炎发生率、重症监护病房（ICU）/呼吸机使用天数和医院死亡率的影响。将当前研究结果与其他随机试验进行比较，并进行荟萃分析。
早期气管切开术的肺炎发生率分别为：苏格曼试验-48.6%，布德卡试验-58.1%，当前研究-46.7%。未进行早期气管切开术的肺炎发生率分别为：苏格曼试验-53.1%，布德卡试验-61.3%，当前研究-44.4%。肺炎发生率的荟萃分析显示，早期气管切开术和未进行早期气管切开术之间无差异（比值比0.89；p = 0.71）。早期气管切开术的ICU/呼吸机使用天数分别为：苏格曼试验-16±5.9，布德卡试验-14.5±7.3，当前研究-14.1±5.7。未进行早期气管切开术的ICU/呼吸机使用天数分别为：苏格曼试验-19±11.3，布德卡试验-17.5±10.6，当前研究-17±5.4。ICU/呼吸机使用天数的荟萃分析显示，早期气管切开术可减少2.9天（p = 0.02）。早期气管切开术的死亡率分别为：苏格曼试验-14.3%，布德卡试验-38.7%，当前研究-0%。未进行早期气管切开术的死亡率分别为：苏格曼试验-3.2%，布德卡试验-22.6%，当前研究-0%。随机试验死亡率的荟萃分析显示，早期气管切开术的死亡率更高（比值比2.68；p = 0.05）。由于随机试验规模较小，因此进行了文献评估，以查找所有描述早期气管切开术与严重脑损伤医院死亡率之间关联的回顾性研究。该综述产生了五项回顾性研究，共3356例患者。回顾性研究死亡率的荟萃分析表明，早期气管切开术的死亡率更高（比值比1.
