早期气管切开术对急性机械通气时间延长患者临床结局的影响：一项单中心研究

Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study.

作者信息

Kang Yewon, Yoo Wanho, Kim Youngwoong, Ahn Hyo Yeong, Lee Sang Hee, Lee Kwangha

机构信息

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

Department of Trauma Surgery, Pusan National University School of Medicine, Busan, Korea.

出版信息

Tuberc Respir Dis (Seoul). 2020 Apr;83(2):167-174. doi: 10.4046/trd.2019.0082.

DOI:10.4046/trd.2019.0082

PMID:32227692

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7105433/

Abstract

BACKGROUND

The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours).

METHODS

Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively.

RESULTS

The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001).

CONCLUSION

Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

摘要

背景

本研究旨在调查早期气管切开术对需要长期急性机械通气（≥96小时）患者临床结局的影响。

方法

回顾性评估了2008年3月至2017年2月在一所大学附属三级护理医院的医学重症监护病房（ICU）住院的575例患者（男性占69.4%；中位年龄68岁）的数据。早期和晚期气管切开术分别定义为经喉插管后2 - 10天和>10天。

结果

90天累积死亡率为47.5%（n = 273），258例患者（44.9%）接受了气管切开术。与晚期组（n = 115）相比，早期组（n = 125）的90天死亡率更低（31.2%对47.8%，p = 0.012），住院和ICU停留时间更短，呼吸机使用时间更短（中位时间分别为43天对54天；24天对33天；23天对28天；所有p < 0.001），转至设有重症监护后护理设施的二级护理医院的比例更高（67.2%对43.5%，p < 0.001）。此外，早期组住院期间的总医疗费用低于晚期组（26,609美元对36,973美元，p < 0.001）。