Gigliotti Jordan, Cheung Godwin, Suhaym Omar, Agnihotram Ramanakumar V, El-Hakim Michel, Makhoul Nicholas
Resident, Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Adjunct Professor, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
J Oral Maxillofac Surg. 2018 Oct;76(10):2231-2240. doi: 10.1016/j.joms.2018.04.005. Epub 2018 Apr 11.
We aimed to describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT).
We implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed enhanced recovery-after-surgery protocol. The primary outcome measurement was hospital length of stay (LOS). The secondary outcome variables were the duration of mechanical ventilation, intensive care unit (ICU) LOS, need for gastrostomy, and airway-related complications directly associated with either NTI or tracheostomy. Descriptive statistics and a multivariate logistic regression analysis were completed.
The sample was composed of 141 patients who had undergone oral cavity FTT for both benign and malignant diseases (NTI, n = 111; tracheostomy, n = 30). Patients managed with NTI had a statistically significantly shorter hospital LOS (8 days vs 15.5 days, P < .0001) and ICU LOS (1 day vs 2 days, P = .0006), as well as a decreased requirement for gastrostomy (17.1% vs 76.7%, P < .0001). Airway-related complications were rare in both the tracheostomy (13.3%) and NTI (3.6%) groups. Multivariate analysis showed that patients undergoing tracheostomy were 3.14 (P = .004) times more likely to have a prolonged hospitalization and 10.4 (P < .0001) times more likely to require a gastrostomy. A sensitivity analysis of only patients with malignant diagnoses had similar statistically significant results. The delayed tracheostomy rate in the NTI group was 3.6%.
To date, this is the largest study to evaluate the use of NTI in patients undergoing oral cavity reconstruction with FTT. Our results suggest that in the appropriate institutional setting, most patients can be safely managed with NTI. This approach results in a decreased hospital LOS and ICU LOS and an earlier resumption of oral intake with less need for gastrostomy.
我们旨在描述在一组接受游离组织移植（FTT）修复口腔缺损的患者中，经鼻气管插管（NTI）的安全性和有效性。
我们开展了一项回顾性队列研究，纳入了2013年至2017年间连续接受口腔、上颌或下颌缺损FTT修复的患者样本。这些患者均遵循新制定的强化术后恢复方案。主要结局指标为住院时间（LOS）。次要结局变量包括机械通气时间、重症监护病房（ICU）住院时间、胃造口术需求以及与NTI或气管切开术直接相关的气道相关并发症。完成了描述性统计和多因素逻辑回归分析。
样本由141例因良性和恶性疾病接受口腔FTT的患者组成（NTI组，n = 111；气管切开术组，n = 30）。接受NTI治疗的患者住院LOS在统计学上显著缩短（8天 vs 15.5天，P <.0001），ICU住院时间也显著缩短（1天 vs 2天，P =.0006），同时胃造口术需求减少（17.1% vs 76.7%，P <.0001）。气管切开术组（13.3%）和NTI组（3.6%）的气道相关并发症均较少见。多因素分析显示，接受气管切开术的患者住院时间延长的可能性高3.14倍（P =.004），需要胃造口术的可能性高10.4倍（P <.0001）。仅对恶性诊断患者进行的敏感性分析也得出了类似的具有统计学意义的结果。NTI组延迟气管切开率为3.6%。
迄今为止，这是评估NTI在接受FTT口腔重建患者中应用的最大规模研究。我们的结果表明，在合适的机构环境下，大多数患者可通过NTI安全管理。这种方法可缩短住院LOS和ICU住院时间，更早恢复经口进食，减少胃造口术需求。
