Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Medicine, University of Barcelona, Barcelona, Spain.
Griffith University School of Medicine, Gold Coast, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
Br J Anaesth. 2022 Nov;129(5):679-692. doi: 10.1016/j.bja.2022.07.032. Epub 2022 Aug 3.
We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications.
Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed.
The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7-18.4; I=99.6%). Pooled mortality was 22.1% (95% CI: 18.7-25.5; I=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0-35.2; I=98.6%) and 38.8 (95% CI: 32.1-45.6; I=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2-1.4], P=0.02 and 0.9 [95% CI: 0.4-1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2-27.7; I=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7-27.8; I=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding.
In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes.
PROSPERO CRD42021272220.
我们对 COVID-19 机械通气患者进行了系统评价，分析了气管切开时机和技术（手术与经皮）对死亡率的影响。次要结局包括重症监护病房（ICU）和住院时间（LOS）、从气管切开处拔管、机械通气持续时间以及并发症。
在 2020 年 1 月 1 日至 2022 年 1 月 10 日之间，我们对四个数据库进行了筛选（PubMed、Embase、Scopus 和 Cochrane）。根据系统评价和荟萃分析的首选报告项目（PRISMA）和人群或问题、干预或暴露、比较和结局（PICO）指南选择论文。对主要结局进行荟萃分析和荟萃回归分析。
搜索结果产生了 9024 篇潜在相关研究，其中 47 篇（n=5268 名患者）被纳入。研究结果之间存在高度的异质性。气管切开术的平均时机为 16.5 天（95%置信区间：14.7-18.4；I=99.6%）。死亡率的汇总平均值为 22.1%（95%置信区间：18.7-25.5；I=89.0%）。荟萃回归未显示死亡率与气管切开时机、机械通气持续时间、拔管时间和气管切开技术之间存在显著关联。ICU 和住院 LOS 的汇总平均估计值分别为 29.6（95%置信区间：24.0-35.2；I=98.6%）和 38.8（95%置信区间：32.1-45.6；I=95.7%）天，两者均与机械通气持续时间相关（系数 0.8[95%置信区间：0.2-1.4]，P=0.02 和 0.9[95%置信区间：0.4-1.4]，P=0.01），但与气管切开时机无关。关于 LOS 的气管切开术技术的数据不足。机械通气持续时间为 23.4 天（95%置信区间：19.2-27.7；I=99.3%），与气管切开时机无关。关于机械通气持续时间与气管切开术技术关系的数据不足。拔管时间为 23.8 天（95%置信区间：19.7-27.8；I=98.7%），不受气管切开时机或技术的影响。最常见的并发症是造口感染、溃疡或坏死和出血。
对于需要气管切开术的 COVID-19 患者，气管切开术的时机和技术似乎并未明显影响患者结局。
PROSPERO CRD42021272220。
Zotero 插件
