Hallan David R, Simion Christopher, Rizk Elias
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2022 Apr 12;14(4):e24059. doi: 10.7759/cureus.24059. eCollection 2022 Apr.
Recent literature supports early tracheostomy (<=7 days) over delayed tracheostomy (>7 days-3 months) to improve overall clinical outcomes for patients admitted with an acute head injury. There is conflicting evidence for the same in hemorrhagic stroke. Using a multi-institutional database, we explored this question in nontraumatic spontaneous intracerebral hemorrhage (sICH) patients.
We used a de-identified database network (TriNetX's Research Network) to gather information on early tracheostomy (<=7 days) and late tracheostomy (>7d-3 months) in sICH patients. After accounting for the most common comorbidities, we explored the impact of this intervention on multiple patient outcomes including intensive care unit (ICU) length of stay, pneumonia, and mortality at 30, 90, and 365 days.
After propensity score matching, a total of 1210 patients were identified for both early tracheostomy (cohort 1) and late tracheostomy (cohort 2) cohorts. The 30-day survival rate was 0.9287 in cohort 1 vs 0.9536 in cohort 2, with a risk difference of 2.39% (95% confidence interval (CI) 0.557%-4.23%; relative risk (RR) 1.54, 95% CI (1.10-2.15); OR 1.577, 95% CI (1.11-2.24); p = 0.006). The 90-day and 365-day end-point survival rates were not statistically different between cohorts. ICU level of care codes were billed an average of 9.76 (SD 8.964) times in cohort 1 vs 14.618 (SD 11.851) in cohort 2 (p<0.0001). At 365 days, there were no differences between the two groups for pulmonary embolism, myocardial infarction, deep venous thrombosis, palliative care consultation, and percutaneous endoscopic gastrostomy tube placement. Cohort 1 had decreased incidence of pneumonia with 665 (54.95%) patients compared to cohort 2 with 725 (59.91%) (RR 0.917, 95% CI (0.856-0.983), OR 0.816, 95% CI (0.695-0.95), p = 0.013).
Early tracheostomy in sICH patients was associated with decreased pneumonia risk, decreased length of ICU care, and no difference in mortality at 90 and 365 days.
近期文献支持早期气管切开术（≤7天）优于延迟气管切开术（>7天至3个月），以改善急性颅脑损伤患者的总体临床结局。在出血性卒中方面，相关证据存在冲突。我们利用多机构数据库，在非创伤性自发性脑出血（sICH）患者中探讨了这个问题。
我们使用了一个去识别化的数据库网络（TriNetX研究网络）来收集sICH患者早期气管切开术（≤7天）和晚期气管切开术（>7天至3个月）的信息。在考虑了最常见的合并症后，我们探讨了这种干预措施对多个患者结局的影响，包括重症监护病房（ICU）住院时间、肺炎以及30天、90天和365天的死亡率。
在倾向评分匹配后，共识别出1210例早期气管切开术（队列1）和晚期气管切开术（队列2）的患者。队列1的30天生存率为0.9287，队列2为0.9536，风险差异为2.39%（95%置信区间（CI）0.557%-4.23%；相对风险（RR）1.54，95%CI（1.10-2.15）；OR 1.577，95%CI（1.11-2.24）；p = 0.006）。队列之间90天和365天的终点生存率无统计学差异。队列1的ICU护理级别代码平均计费9.76（标准差8.964）次，队列2为14.618（标准差11.851）次（p<0.0001）。在365天时，两组在肺栓塞、心肌梗死、深静脉血栓形成、姑息治疗会诊和经皮内镜胃造瘘管置入方面无差异。队列1的肺炎发病率降低，有665例（54.95%）患者，而队列2有725例（59.91%）（RR 0.917，95%CI（0.856-0.983），OR 0.816，95%CI（0.695-0.95），p = 0.013）。
sICH患者早期气管切开术与肺炎风险降低、ICU护理时间缩短以及90天和365天死亡率无差异相关。
