12247University of Illinois at Chicago, Chicago, IL, USA.
1466Johns Hopkins University, Baltimore, MD, USA.
J Intensive Care Med. 2022 Feb;37(2):240-247. doi: 10.1177/08850666211045896. Epub 2021 Oct 12.
Patients with COVID-19 ARDS require significant amounts of sedation and analgesic medications which can lead to longer hospital/ICU length of stay, delirium, and has been associated with increased mortality. Tracheostomy has been shown to decrease the amount of sedative, anxiolytic and analgesic medications given to patients. The goal of this study was to assess whether tracheostomy decreased sedation and analgesic medication usage, improved markers of activity level and cognitive function, and clinical outcomes in patients with COVID-19 ARDS.
A retrospective registry of patients with COVID-19 ARDS who underwent tracheostomy creation at the University of Pennsylvania Health System or the Johns Hopkins Hospital from 3/2020 to 12/2020. Patients were grouped into the early (≤14 days, = 31) or late (15 + days, = 97) tracheostomy groups and outcome data collected.
128 patients had tracheostomies performed at a mean of 19.4 days, with 66% performed percutaneously at bedside. Mean hourly dose of fentanyl, midazolam, and propofol were all significantly reduced 48-h after tracheostomy: fentanyl (48-h pre-tracheostomy: 94.0 mcg/h, 48-h post-tracheostomy: 64.9 mcg/h, = .000), midazolam (1.9 mg/h pre vs. 1.2 mg/h post, = .0012), and propofol (23.3 mcg/kg/h pre vs. 8.4 mcg/kg/h post, = .0121). There was a significant improvement in mobility score and Glasgow Coma Scale in the 48-h pre- and post-tracheostomy. Comparing the early and late groups, the mean fentanyl dose in the 48-h pre-tracheostomy was significantly higher in the late group than the early group (116.1 mcg/h vs. 35.6 mcg/h, = .03). ICU length of stay was also shorter in the early group (37.0 vs. 46.2 days, = .012).
This data supports a reduction in sedative and analgesic medications administered and improvement in cognitive and physical activity in the 48-h period post-tracheostomy in COVID-19 ARDS. Further, early tracheostomy may lead to significant reductions in intravenous opiate medication administration, and ICU LOS.
患有 COVID-19 急性呼吸窘迫综合征（ARDS）的患者需要大量的镇静和镇痛药物，这可能导致住院/重症监护病房（ICU）时间延长、出现谵妄，并与死亡率增加有关。气管切开术已被证明可以减少给予患者的镇静剂、抗焦虑药和镇痛药的用量。本研究的目的是评估气管切开术是否可以减少 COVID-19 ARDS 患者的镇静和镇痛药物使用量、改善活动水平和认知功能的标志物，并改善临床结局。
这是一项回顾性登记研究，纳入了 2020 年 3 月至 2020 年 12 月期间在宾夕法尼亚大学卫生系统或约翰霍普金斯医院接受气管切开术的 COVID-19 ARDS 患者。患者被分为早期（≤14 天，n=31）或晚期（15+天，n=97）气管切开术组，并收集了结局数据。
共有 128 名患者接受了气管切开术，平均时间为 19.4 天，其中 66%在床边行经皮气管切开术。气管切开术后 48 小时，芬太尼、咪达唑仑和丙泊酚的每小时剂量均显著降低：芬太尼（48 小时前：94.0 mcg/h，48 小时后：64.9 mcg/h，p=0.000）、咪达唑仑（1.9 mg/h 前 vs. 1.2 mg/h 后，p=0.0012）和丙泊酚（23.3 mcg/kg/h 前 vs. 8.4 mcg/kg/h 后，p=0.0121）。在气管切开术前后 48 小时，患者的活动能力评分和格拉斯哥昏迷评分均显著改善。比较早晚期组，晚期组气管切开术 48 小时前芬太尼剂量明显高于早期组（116.1 mcg/h vs. 35.6 mcg/h，p=0.03）。早期组 ICU 住院时间也较短（37.0 天 vs. 46.2 天，p=0.012）。
本数据支持 COVID-19 ARDS 患者在气管切开术后 48 小时内镇静和镇痛药物用量减少，并改善认知和躯体活动能力。此外，早期气管切开术可能会显著减少静脉阿片类药物的使用以及 ICU 住院时间。
