3883Royal Brisbane and Womens Hospital, Brisbane, Queensland, Australia.
Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia.
J Intensive Care Med. 2020 Nov;35(11):1153-1161. doi: 10.1177/0885066619837939. Epub 2019 Mar 21.
Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs.
Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion.
Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose ( value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference ( value = .46) in the amount of PRC used post-TT.
These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.
有报道称，接受体外膜肺氧合（ECMO）支持的患者需要增加镇静要求。在重症监护室进行气管切开术是为了促进长期机械通气、减少镇静、改善患者舒适度、分泌物清除以及说话和吞咽能力。我们旨在研究 ECMO 上气管切开术（TT）的安全性、对液体摄入的影响以及镇静、镇痛和血管活性药物的使用。
在 5.5 年的时间里，对所有接受 ECMO 的患者进行了前瞻性数据收集。数据包括镇静和镇痛药物的累积剂量、液体平衡、正性肌力药和血管加压药的需求以及输注的红细胞压积（PRC）单位数。分析数据以确定 TT 前 5 天和 TT 后上述各项之间的差异。
在研究期间，140 名患者中有 31 名（22.1%）在接受 ECMO 治疗时接受了 TT。与 TT 前剂量相比，TT 后时期的正性肌力药和血管加压药使用显著减少（ 值=.01）。这是在 TT 前一天的序贯器官衰竭评估评分明显大于 TT 后第 2、3 和 4 天的情况下。TT 后时期镇痛药物的使用呈减少趋势。未报告 TT 的主要并发症。TT 后 PRC 的使用量无显著差异（ 值=.46）。
这些数据表明 TT 可能导致血管加压药和正性肌力药需求减少。数据并未表明在 ECMO 患者中放置 TT 会增加大出血的风险。在 ECMO 患者中插入 TT 的潜在风险和益处需要进一步在前瞻性临床研究中验证。
