Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia.
Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Northside Medical School, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
Aust Crit Care. 2020 May;33(3):213-218. doi: 10.1016/j.aucc.2020.02.006. Epub 2020 Apr 13.
Conjecture remains regarding the optimal timing for tracheostomy. Most studies examine patient mortality, ventilation duration, intensive care unit (ICU) length of stay, and medical complications. Few studies examine patient-centric outcomes. The aim of this study was to determine whether timing of tracheostomy had an impact on length of stay, morbidity, mortality, and patient-centric outcomes towards their functional recovery.
This prospective observational study included data for all tracheostomised patients over 4 y in a tertiary ICU. The study time period commenced with the insertion of an endotracheal tube. Data collected included patient and disease specifics; mortality up to 4 y; mobility scores; and time to oral intake, talking, and out-of-bed exercises. To assess differences between timing of tracheostomy, a survival analysis was conducted to dynamically compare patients on days before and after tracheostomy tube (TT) placement during their ICU admission.
TT was placed in 276 patients. After tracheostomy, the patients were able to (on average) verbally communicate 7.4 d earlier (confidence interval [CI] = -9.1 to -4.9), return to oral intake 7.0 d earlier (CI = -10 to -4.6), and perform out-of-bed exercises 6.2 d earlier (CI = -8.4 to -4) than those who did not yet have a TT. In patients with an endotracheal tube, none were able to talk or have oral intake, and the majority (99%) did not participate in out-of-bed exercises/active rehabilitation. After tracheostomy, patients subsequently received significantly less analgesic and sedative drugs and more antipsychotics. No clear differences in ICU and long-term mortality were associated with tracheostomy timing.
Earlier tracheostomy is associated with earlier achievement of patient-centric outcomes - patients returning to usual daily activities such as talking, out-of-bed mobility, and eating/drinking significantly earlier, whilst also receiving less sedatives and analgesics.
关于气管切开术的最佳时机仍存在推测。大多数研究都检查了患者死亡率、通气时间、重症监护病房（ICU）住院时间和医疗并发症。很少有研究检查以患者为中心的结果。本研究旨在确定气管切开术的时机是否对住院时间、发病率、死亡率以及患者对其功能恢复的以患者为中心的结果产生影响。
这项前瞻性观察性研究包括在一家三级 ICU 接受气管切开术的所有患者的数据，研究时间从插入气管内管开始。收集的数据包括患者和疾病特征；4 年内的死亡率；活动能力评分；以及开始口服摄入、说话和离床锻炼的时间。为了评估气管切开术时机的差异，进行了生存分析，以动态比较 ICU 住院期间气管切开管（TT）放置前和放置后天数的患者。
276 例患者放置了 TT。气管切开术后，患者能够提前（平均）7.4 天进行口头交流（置信区间 [CI] = -9.1 至 -4.9），提前 7.0 天恢复口服摄入（CI = -10 至 -4.6），提前 6.2 天进行离床锻炼（CI = -8.4 至 -4），而那些尚未进行 TT 的患者则无法进行。在使用气管内管的患者中，没有一个人能够说话或口服摄入，而且大多数（99%）人没有进行离床锻炼/主动康复。气管切开术后，患者随后接受的镇痛和镇静药物明显减少，而抗精神病药物则增加。与气管切开术时机无关的 ICU 和长期死亡率没有明显差异。
早期气管切开术与以患者为中心的结果的更早实现相关-患者更早地恢复到日常活动，如说话、离床活动和进食/饮水，同时接受的镇静剂和镇痛药也更少。
