COVID-19 相关急性呼吸衰竭患者的气管切开术实践——来自 PRoVENT-COVID 研究的见解。
Practice of tracheostomy in patients with acute respiratory failure related to COVID-19 - Insights from the PRoVENT-COVID study.
机构信息
Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands.
Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands.
出版信息
Pulmonology. 2022 Jan-Feb;28(1):18-27. doi: 10.1016/j.pulmoe.2021.08.012. Epub 2021 Sep 20.
OBJECTIVE
Invasively ventilated patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) potentially benefit from tracheostomy. The aim of this study was to determine the practice of tracheostomy during the first wave of the pandemic in 2020 in the Netherlands, to ascertain whether timing of tracheostomy had an association with outcome, and to identify factors that had an association with timing.
METHODS
Secondary analysis of the 'PRactice of VENTilation in COVID-19' (PRoVENT-COVID) study, a multicenter observational study, conducted from March 1, 2020 through June 1, 2020 in 22 Dutch intensive care units (ICU) in the Netherlands. The primary endpoint was the proportion of patients receiving tracheostomy; secondary endpoints were timing of tracheostomy, duration of ventilation, length of stay in ICU and hospital, mortality, and factors associated with timing.
RESULTS
Of 1023 patients, 189 patients (18.5%) received a tracheostomy at median 21 [17 to 28] days from start of ventilation. Timing was similar before and after online publication of an amendment to the Dutch national guidelines on tracheostomy focusing on COVID-19 patients (21 [17-28] vs. 21 [17-26] days). Tracheostomy performed ≤ 21 days was independently associated with shorter duration of ventilation (median 26 [21 to 32] vs. 40 [34 to 47] days) and higher mortality in ICU (22.1% vs. 10.2%), hospital (26.1% vs. 11.9%) and at day 90 (27.6% vs. 14.6%). There were no patient demographics or ventilation characteristics that had an association with timing of tracheostomy.
CONCLUSIONS
Tracheostomy was performed late in COVID-19 patients during the first wave of the pandemic in the Netherlands and timing of tracheostomy possibly had an association with outcome. However, prospective studies are needed to further explore these associations. It remains unknown which factors influenced timing of tracheostomy in COVID-19 patients.
目的
与 2019 年冠状病毒病（COVID-19）相关的急性呼吸衰竭的有创通气患者可能受益于气管切开术。本研究的目的是确定 2020 年大流行第一波期间荷兰气管切开术的实施情况，确定气管切开术时机与结局的关系，并确定与时机相关的因素。
方法
对多中心观察性研究“VENTilation in COVID-19（PRoVENT-COVID）”的二次分析，该研究于 2020 年 3 月 1 日至 6 月 1 日在荷兰 22 家荷兰重症监护病房（ICU）进行。主要终点是接受气管切开术的患者比例；次要终点是气管切开术时机、通气时间、ICU 和医院住院时间、死亡率以及与时机相关的因素。
结果
在 1023 例患者中，189 例（18.5%）患者在开始通气后中位数 21 [17 至 28] 天接受气管切开术。在荷兰国家气管切开术指南在线修订版（重点关注 COVID-19 患者）发表前后，时机相似（21 [17-28] 与 21 [17-26] 天）。气管切开术≤21 天与通气时间缩短（中位数 26 [21 至 32] 与 40 [34 至 47] 天）和 ICU 死亡率升高（22.1% 与 10.2%）、医院（26.1% 与 11.9%）和第 90 天（27.6% 与 14.6%）独立相关。患者的人口统计学或通气特征与气管切开术时机没有关联。
结论
在荷兰大流行第一波期间，COVID-19 患者的气管切开术实施较晚，气管切开术时机可能与结局相关。然而，需要进一步探索这些关联的前瞻性研究。尚不清楚哪些因素影响了 COVID-19 患者气管切开术的时机。
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