早期气管切开术治疗小儿重度创伤性脑损伤与减少重症监护病房住院时间和总呼吸机天数有关。

Early Tracheostomy for Severe Pediatric Traumatic Brain Injury is Associated with Reduced Intensive Care Unit Length of Stay and Total Ventilator Days.

机构信息

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, 8788University of California, Irvine, Orange, CA, USA.

Department of Anesthesia, 5116University of Southern California, Los Angeles, CA, USA.

出版信息

J Intensive Care Med. 2020 Nov;35(11):1346-1351. doi: 10.1177/0885066619870153. Epub 2019 Aug 27.

DOI:10.1177/0885066619870153

PMID:31455142

Abstract

OBJECTIVES

To determine whether, similar to adults, early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) improves inhospital outcomes including ventilator days, intensive care unit (ICU) length of stay (LOS), and total hospital LOS when compared to late tracheostomy.

DESIGN

Retrospective cohort analysis.

SETTING

The Pediatric Trauma Quality Improvement Program (TQIP) database.

PATIENTS

One hundred twenty-seven pediatric patients <16 years old with severe (>3) abbreviated injury scale TBI who underwent early (days 1-6) or late (day ≥7) tracheostomy between 2014 and 2016.

INTERVENTIONS

Not applicable.

MEASUREMENTS AND MAIN RESULTS

The Pediatric TQIP database was queried for patients <16 years old with severe TBI, who underwent tracheostomy. Patient demographics and outcomes of early versus late tracheostomy were compared using Student t test, Mann-Whitney U test, and χ2 analysis. Sixteen patients underwent early tracheostomy while 111 underwent late tracheostomy. The groups had similar distributions of age, gender, mechanism of injury, and mean injury severity scores (P > .05). Early tracheostomy was associated with decreased ICU LOS (early: 17 vs late: 32 days, P < .05) and ventilator days (early: 9.7 vs late: 27.1 days, P < .05). There was no difference in total LOS (early: 26.7 vs late: 41.3 days, P = .06), the incidence of acute respiratory distress syndrome (early: 6.3% vs late: 2.7%, P = .45), pneumonia (early: 12.5% vs late: 29.7%, P = .15), or mortality (early: 0% vs late: 2%, P = .588) between the 2 groups.

CONCLUSION

Similar to adults, early tracheostomy in pediatric patients with severe TBI is associated with decreased ICU LOS and ventilator days. Future prospective trials are needed to confirm these findings.

ARTICLE TWEET

Early tracheostomy in pediatric patients with severe TBI is associated with decreased ICU LOS and ventilator days.

摘要

目的

确定在儿童严重创伤性脑损伤（TBI）患者中，早期气管切开术是否与成人相似，通过比较晚期气管切开术，改善住院期间的结果，包括呼吸机使用天数、重症监护病房（ICU）住院时间（LOS）和总住院 LOS。

设计

回顾性队列分析。

设置

儿科创伤质量改进计划（TQIP）数据库。

患者

2014 年至 2016 年间，127 名年龄<16 岁、有严重（>3）简明损伤量表 TBI 的患儿行早期（第 1-6 天）或晚期（第≥7 天）气管切开术。

干预措施

不适用。

测量和主要结果

查询儿科 TQIP 数据库，获取年龄<16 岁、有严重 TBI、行气管切开术的患者。使用学生 t 检验、Mann-Whitney U 检验和χ2 分析比较早期与晚期气管切开术的患者人口统计学特征和结果。16 例患者行早期气管切开术，111 例患者行晚期气管切开术。两组患者的年龄、性别、损伤机制和平均损伤严重程度评分分布相似（P>0.05）。早期气管切开术与 ICU LOS 缩短相关（早期：17 天 vs 晚期：32 天，P<0.05）和呼吸机使用天数减少（早期：9.7 天 vs 晚期：27.1 天，P<0.05）。两组总 LOS 无差异（早期：26.7 天 vs 晚期：41.3 天，P=0.06）、急性呼吸窘迫综合征发生率（早期：6.3% vs 晚期：2.7%，P=0.45）、肺炎（早期：12.5% vs 晚期：29.7%，P=0.15）或死亡率（早期：0% vs 晚期：2%，P=0.588）。