Romain Marc, Vysokovsky Moshe, Vernon van-Heerden Peter, Stav Ilana, Sviri Sigal
Medical Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
General Intensive Care Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Isr Med Assoc J. 2020 Oct;22(10):633-638.
In Israel, critically ill patients are ventilated and managed in intensive care units or general wards.
To compare the mortality rates and long-term cognitive and functional outcomes of ventilated patients who underwent tracheostomy insertion in the Medical ICU (MICU) versus those cared for in the in-patient wards.
The study comprised 170 patients who underwent percutaneous dilatational tracheostomy (PDT) over an 18-month period in the MICU (n=102) and in in-patient wards (internal medicine and neurology) (n=68). Telephone interviews were conducted with living patients and/or their relatives at least 6 months after discharge from the hospital.
Ward patients were 10 years older than ICU patients undergoing PDT (P = 0.003). The length of stay (LOS) in the wards was longer than in the ICU (P < 0.001), whereas the total LOS in the hospital was similar (P = 0.43). ICU mortality was lower than in the wards (P = 0.001) but hospital mortality was comparable between the two groups (P = 0.17). At 6 months follow-up more ICU patients were fully conscious, weaned from ventilation, and decannulated. More patients in the ICU group were at home and were independent or had mildly impaired activities of daily living. More patients in the ward group were residing in long-term care facilities with functional limitations.
MICU patients who undergo tracheostomy may have a good long-term functional and cognitive outcome. More studies are needed to further assess long-term outcomes in these patients.
在以色列，重症患者在重症监护病房或普通病房接受通气和治疗。
比较在医学重症监护病房（MICU）接受气管切开术的通气患者与在住院病房接受治疗的患者的死亡率以及长期认知和功能结局。
该研究纳入了170例在18个月期间于MICU（n = 102）和住院病房（内科和神经科）（n = 68）接受经皮扩张气管切开术（PDT）的患者。在患者出院至少6个月后，对在世患者和/或其亲属进行电话访谈。
病房患者比接受PDT的ICU患者大10岁（P = 0.003）。病房的住院时间（LOS）比ICU长（P < 0.001），而医院的总住院时间相似（P = 0.43）。ICU的死亡率低于病房（P = 0.001），但两组的医院死亡率相当（P = 0.17）。在6个月的随访中，更多的ICU患者完全清醒、脱机并拔管。ICU组中更多患者在家中，独立或日常生活活动轻度受损。病房组中更多患者居住在功能受限的长期护理机构。
接受气管切开术的MICU患者可能具有良好的长期功能和认知结局。需要更多研究来进一步评估这些患者的长期结局。
