Mehta Sangeeta, Brondani Anita, Tomlinson George, Chu Leslie, Burns Stacey, Matte Andrea, Cameron Jill I, Friedrich Jan O, Rudkowski Jill, Robles Priscila, Skrobik Yoanna, Herridge Margaret, Adhikari Neill K J
Department of Medicine, Sinai Health System, Toronto, ON, Canada.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Crit Care Explor. 2022 Oct 7;4(10):e0768. doi: 10.1097/CCE.0000000000000768. eCollection 2022 Oct.
Tracheostomy is commonly performed in critically ill patients requiring prolonged mechanical ventilation (MV). We evaluated the outcomes of tracheostomy in patients who received greater than or equal to 1 week MV and were followed for 1 year.
In this secondary analysis of a prospective observational study, we compared outcomes in tracheostomy versus nontracheostomy patients. Outcomes post ICU included Functional Independence Measure (FIM) subscales, 6-Minute Walk Test (6MWT), Short Form 36 (SF36), Medical Research Council (MRC) Scale, pulmonary function tests (PFTs), Impact of Event Scale (IES), Beck Depression Inventory-II (BDI-II), and vital status and disposition.
Nine University affiliated ICUs in Canada.
Medical/surgical patients requiring MV for 7 or more days who were enrolled in the Towards RECOVER Study.
Of 398 ICU survivors, 193 (48.5%) received tracheostomy, on median ICU day 14 (interquartile range [IQR], 8-0 d). Patients with tracheostomy were older, had similar severity of illness, had longer MV duration and ICU and hospital stays, and had higher risk of ICU readmission (odds ratio [OR], 1.9; 95% CI, 1.0-3.2) and hospital mortality (OR, 2.6; 95% CI, 1.1-6.1), but not 1-year mortality (hazard ratio, 1.41; 95% CI, 0.88-1.2). Over 1 year, tracheostomy patients had lower FIM-Total (7.7 points; 95% CI, 2.2-13.2); SF36, IES, and BDI-II were similar. From 3 months, tracheostomy patients had 12% lower 6MWT ( = 0.0008) and lower MRC score (3.4 points; = 0.006). Most PFTs were 5-8% lower in the tracheostomy group. Tracheostomy patients had similar specialist visits (rate ratio, 0.63; 95% CI, 0.28-2.4) and hospital readmissions (OR, 0.82; 95% CI, 0.54-1.3) but were less likely to be at home at hospital discharge and 1 year.
Patients who received tracheostomy had more ICU and hospital care and higher hospital mortality compared with patients who did not receive a tracheostomy. In 1 year follow-up, tracheostomy patients required a higher daily burden of care, expressed by FIM.
气管切开术常用于需要长期机械通气（MV）的危重症患者。我们评估了接受MV≥1周并随访1年的患者气管切开术的结局。
在这项前瞻性观察性研究的二次分析中，我们比较了气管切开术患者与未行气管切开术患者的结局。ICU后的结局包括功能独立性测量（FIM）子量表、6分钟步行试验（6MWT）、简明健康状况调查量表（SF-36）、医学研究委员会（MRC）量表、肺功能测试（PFT）、事件影响量表（IES）、贝克抑郁量表第二版（BDI-II）以及生命状态和处置情况。
加拿大9家大学附属医院的ICU。
参加“走向康复研究”的需要MV≥7天的内科/外科患者。
在398名ICU幸存者中，193名（48.5%）接受了气管切开术，气管切开术的中位ICU日为第14天（四分位间距[IQR]，8 - 20天）。接受气管切开术的患者年龄较大，疾病严重程度相似，MV持续时间、ICU和住院时间更长，ICU再入院风险更高（比值比[OR]，1.9；95%置信区间[CI]，1.0 - 3.2）和医院死亡率更高（OR，2.6；95% CI，1.1 - 6.1），但1年死亡率无差异（风险比，1.41；95% CI，0.88 - 1.2）。在1年期间，气管切开术患者的FIM总分较低（7.7分；95% CI，2.2 - 13.2）；SF-36、IES和BDI-II相似。从3个月起，气管切开术患者的6MWT降低12%（P = 0.0008），MRC评分降低（3.4分；P = 0.006）。气管切开术组大多数PFT降低5% - 8%。气管切开术患者的专科就诊次数相似（率比，0.63；95% CI，0.28 - 2.4）和医院再入院率相似（OR，0.82；95% CI，0.54 - 1.3），但出院时和1年时在家中的可能性较小。
与未接受气管切开术的患者相比，接受气管切开术的患者接受了更多的ICU和医院护理，医院死亡率更高。在1年的随访中，气管切开术患者需要更高的每日护理负担，这通过FIM得以体现。
