Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Acta Anaesthesiol Scand. 2022 Sep;66(8):996-1002. doi: 10.1111/aas.14105. Epub 2022 Jun 24.
Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction, or surgery in the face/neck region. However, practices regarding the timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period.
A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007 and 2020. Data were retrieved from hospital records on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression.
A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was 9 days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%. The one- and five-year survival rate was 60% and 44%, respectively.
We describe a whole-nation practice of tracheostomies. A notable finding is the relatively low rate of extubation attempts prior to tracheostomy insertion. Future work should focus on standardization of assessing the need for tracheostomy and the role of extubation attempts prior to tracheostomy placement.
由于长时间机械通气、上呼吸道阻塞或头颈部手术，气管切开术常在 ICU 患者中使用。然而，关于放置和使用的时机的实践存在差异。本研究提供了 14 年来 ICU 中气管切开术使用和结果的全国性概述。
这是一项回顾性研究，纳入了 2007 年至 2020 年期间在冰岛 ICU 住院期间接受气管切开术的所有患者。数据从医院记录中获取，包括入院原因、合并症、气管切开术插入的指征、气管切开术前和术后机械通气的持续时间、拔管尝试、并发症、ICU 和住院时间以及生存率。提供了描述性统计数据，并使用 Cox 回归进行了生存分析。
研究期间共有 336 名患者（中位数年龄 64 岁，33%为女性）接受了气管切开术。气管切开术最常见的指征是呼吸衰竭，其次是神经系统疾病。气管切开术前机械通气的中位数持续时间为 9 天，35%的病例至少尝试过一次拔管。经皮气管切开术占 32%。总体并发症发生率为 25%，最常见的短期并发症是出血（5%）。院内死亡率为 33%。一年和五年的生存率分别为 60%和 44%。
我们描述了一种全国性的气管切开术实践。一个值得注意的发现是，在气管切开术前尝试拔管的比例相对较低。未来的工作应侧重于规范评估气管切开术的必要性以及气管切开术前拔管尝试的作用。
