Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
Eur J Med Res. 2022 Jul 26;27(1):132. doi: 10.1186/s40001-022-00753-5.
AIMS: This study was undertaken to evaluate our tracheostomy service and identify reasons for any delays.
A retrospective study in an academic tertiary-care hospital in Jeddah, Saudi Arabia. Inclusion criteria were any patients in ICU who required a surgical tracheostomy over a 2-year period (January 2014 to December 2015). The primary outcome was delayed tracheostomy referral and secondary outcomes included the number of days between referral and consultation, days between consultation and tracheostomy placement, and mortality rates.
Ninety-nine patients had a tracheostomy between January 2014 to December 2015 and could be analysed, mean age of 52.7 years, 44.5% females. The average duration from referral to tracheostomy was 5.12 days (SD 6.52). Eighteen patients (18.2%) had delayed tracheostomy (> 7 days from referral). The main reasons for the delay were the patient's medical condition (50%, n = 9), followed by low haemoglobin (38.9%, n = 7). Administrative reasons were recorded in 5 cases only (28%); 2 due to operating room lack of time, 2 due to multidisciplinary issues, and 1 due to family refusal. Laboratory-confirmed low haemoglobin, a prescription of anti-platelets, or a prescription of anti-coagulation were not associated with a longer duration between referral and tracheostomy placement. An increase of 1 day in the time between referral and tracheostomy corresponded to an increase in delay in discharge from ICU of 1.24 days (95% CI 0.306 to 2.18).
Although most delays related to the clinical condition of the patient, administrative and multidisciplinary factors also play a role. Early tracheostomy (less than 14 days) from intubation increases the survival rates of patients and improves their clinical outcomes. Further prospective evaluation is needed to confirm the impact of delay in performing surgical tracheostomy among ICU patients whose bedside percutaneous tracheostomy is contraindicated.
目的：本研究旨在评估我们的气管切开术服务，并确定任何延迟的原因。
这是在沙特阿拉伯吉达的一家学术性三级保健医院进行的回顾性研究。纳入标准为在 2 年内（2014 年 1 月至 2015 年 12 月）需要在 ICU 进行手术气管切开术的任何患者。主要结局是延迟的气管切开术转诊，次要结局包括转诊至咨询的天数、咨询至气管切开术放置的天数以及死亡率。
在 2014 年 1 月至 2015 年 12 月期间，99 例患者进行了气管切开术，可以进行分析，平均年龄为 52.7 岁，女性占 44.5%。从转诊到气管切开术的平均时间为 5.12 天（SD 6.52）。18 例（18.2%）患者发生延迟气管切开术（转诊后超过 7 天）。延迟的主要原因是患者的病情（50%，n=9），其次是低血红蛋白（38.9%，n=7）。仅记录了 5 例行政原因（28%）；2 例是由于手术室缺乏时间，2 例是由于多学科问题，1 例是由于家属拒绝。实验室确认的低血红蛋白、抗血小板药物的处方或抗凝药物的处方与转诊至气管切开术的时间之间没有更长的关联。转诊至气管切开术的时间增加 1 天，ICU 出院时间延迟增加 1.24 天（95%CI 0.306 至 2.18）。
尽管大多数延迟与患者的临床状况有关，但行政和多学科因素也发挥了作用。早期（<14 天）从插管进行气管切开术可提高患者的生存率并改善其临床结局。需要进一步前瞻性评估，以确认在因床边经皮气管切开术禁忌而不能进行手术气管切开术的 ICU 患者中，延迟进行手术气管切开术的影响。
