Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX, USA.
Department of Preventive Care and Community Medicine, UTMB, Galveston, TX, USA.
J Intensive Care Med. 2020 Jun;35(6):576-582. doi: 10.1177/0885066618770380. Epub 2018 Apr 22.
Although pulmonary and/or critical care (P/CC) physicians perform percutaneous tracheostomy in mechanically ventilated patients, the trends, timing, and outcomes of this procedure have not been well described. This study aims to describe the trends, timing, and outcomes of this procedure.
Using 5% medicare data, we retrospectively examined a cohort who had tracheostomy performed after initiation of mechanical ventilation during acute hospitalization to describe the timing of tracheostomy placement by pulmonary and/or critical care (P/CC) physicians and associated outcomes.
There were 4864 participants in the study cohort from 2007 to 2014. We examined the timing of tracheostomy (in days from initiation of mechanical ventilation), length of hospital stay, in-hospital death, and death within 30 days after hospital discharge. The percentage of tracheostomies performed by P/CC physicians increased significantly, from 7.2% in 2007 to 14.1% in 2014 (Cochran-Armitage test for trend, = .001). Tracheostomies performed by P/CC physicians were more common in larger hospitals and major academic medical centers. After adjustment for baseline characteristics, the following parameters did not differ by provider: time to tracheostomy, length of hospital stay (days), in-hospital death, and death within 30 days after discharge. A tracheostomy was more likely to be performed by a P/CC physician at a larger (≥500 beds) hospital (adjusted odds ratio: 1.85, 95% confidence interval: 1.47-2.34).
Tracheostomies are increasingly performed by P/CC physicians with similar outcomes, likely related to patient selection.
尽管肺部和/或重症监护（P/CC）医师在机械通气患者中进行经皮气管切开术，但该手术的趋势、时机和结果尚未得到很好的描述。本研究旨在描述该手术的趋势、时机和结果。
使用 5%的医疗保险数据，我们回顾性地检查了一组在急性住院期间开始机械通气后进行气管切开术的患者，以描述肺部和/或重症监护（P/CC）医师进行气管切开术的时机以及与相关的结局。
在 2007 年至 2014 年期间，研究队列中有 4864 名参与者。我们检查了气管切开术的时机（从开始机械通气到气管切开术的天数）、住院时间、住院期间死亡和出院后 30 天内死亡的情况。由 P/CC 医师进行的气管切开术的比例显著增加，从 2007 年的 7.2%增加到 2014 年的 14.1%（Cochran-Armitage 趋势检验，=.001）。在更大的医院和主要学术医疗中心，由 P/CC 医师进行的气管切开术更为常见。在调整基线特征后，以下参数在提供者之间没有差异：气管切开术的时间、住院时间（天）、住院期间死亡和出院后 30 天内死亡。在更大（≥500 张床）的医院，更有可能由 P/CC 医师进行气管切开术（调整后的优势比：1.85，95%置信区间：1.47-2.34）。
越来越多的 P/CC 医师进行气管切开术，结果相似，这可能与患者选择有关。
