Moussa Mohamad K, Moussa Ali, Nasr Firas, Khalaf Zaynab, Sarout Safaa, Moukarzel Nabil, Dib Alfred
Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Beirut, LBN.
Pediatrics, Lebanese University, Faculty of Medical Sciences, Beirut, LBN.
Cureus. 2020 Nov 6;12(11):e11361. doi: 10.7759/cureus.11361.
Background Benefits of early tracheostomy (ET) versus late tracheostomy (LT) while treating critically ill patients have been a matter of big debate in the last few years. Several meta-analyses tried to prove the benefits of ET in decreasing the duration of mechanical ventilation (MV), the length of intensive care unit (ICU) stay, and the mortality rates. However, no clear guidelines are available yet. This study will focus on comparing the outcomes of early tracheostomy versus late one. Methods This is a retrospective study done in two medical and surgical ICUs at "Sacre-Coeur Hospital" and "Rafik Hariri University Hospital" at Beirut, where we reviewed various files of patients who underwent elective tracheostomy for prolonged MV from January 2015 to June 2016. ET and LT were assumed to be procedures performed respectively before and after 10 days of MV. These two groups were subdivided based on the Acute Physiology and Chronic Health Evaluation II (APACHE II) score calculated in the first 24 hours of ICU admission. Data about short- and long-term mortality, the duration of MV, and the length of ICU stay were collected and compared. Results From a total of 45 patients, only 25 patients met the inclusion and exclusion criteria of whom 12 (48%) underwent ET and 13 (52%) patients underwent LT. In patients with APACHE II <25 (6 ET and 6 LT), ET was associated with 50% long-term mortality, 9.6 days mean duration of MV and 23 days mean length of ICU stay compared to 57% (P-value=0.05), 78 days (P-value=0.04) and 79 days (P-value=0.012) of respective parameters in LT groups. In patients with APACHE II >25 (6 ET and 7 LT), ET was associated with 50% long-term mortality, 8.6 days mean duration of MV and 24 days mean length of ICU stay compared to 84%, 105 days, 84 days of respective parameter in LT groups. Conclusions Our results are suggestive of the superiority of ET because it was associated with a reduced duration of MV, a decrease in the length of ICU stay, and, most importantly, a lower long-term mortality rate.
背景 在过去几年中，在治疗重症患者时，早期气管切开术（ET）与晚期气管切开术（LT）的益处一直是一个备受争议的问题。多项荟萃分析试图证明ET在缩短机械通气（MV）时间、重症监护病房（ICU）住院时间和降低死亡率方面的益处。然而，目前尚无明确的指南。本研究将重点比较早期气管切开术与晚期气管切开术的结果。方法 这是一项在贝鲁特的“圣心医院”和“拉菲克·哈里里大学医院”的两个内科和外科ICU进行的回顾性研究，我们回顾了2015年1月至2016年6月期间因长时间MV而接受择期气管切开术的患者的各种病历。ET和LT分别被假定为在MV 10天之前和之后进行的手术。这两组根据ICU入院后24小时内计算的急性生理与慢性健康状况评分II（APACHE II）进行细分。收集并比较了短期和长期死亡率、MV持续时间和ICU住院时间的数据。结果 在总共45例患者中，只有25例患者符合纳入和排除标准，其中12例（48%）接受了ET，13例（52%）患者接受了LT。在APACHE II<25的患者中（6例ET和6例LT），ET组的长期死亡率为50%，平均MV持续时间为9.6天，平均ICU住院时间为23天，而LT组相应参数分别为57%（P值=0.05）、78天（P值=0.04）和79天（P值=0.012）。在APACHE II>25的患者中（6例ET和7例LT），ET组的长期死亡率为50%，平均MV持续时间为8.6天，平均ICU住院时间为24天，而LT组相应参数分别为84%、105天、84天。结论我们的结果表明ET具有优越性，因为它与MV持续时间缩短、ICU住院时间减少相关，最重要的是，长期死亡率较低。
