Chen Jing-Ran, Gao Hao-Ran, Yang Yan-Lin, Wang Yan, Zhou Yi-Min, Chen Guang-Qiang, Li Hong-Liang, Zhang Linlin, Zhou Jian-Xin
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Front Med (Lausanne). 2022 Dec 14;9:1068569. doi: 10.3389/fmed.2022.1068569. eCollection 2022.
To evaluate the association of tracheostomy timing with all-cause mortality in patients with mechanical ventilation (MV).
It's a retrospective cohort study. Adult patients undergoing invasive MV who received tracheostomy during the same hospitalization based on the Medical Information Mart for Intensive Care-III (MIMIC-III) database, were selected. The primary outcome was the relationship between tracheostomy timing and 90-day all-cause mortality. A restricted cubic spline was used to analyze the potential non-linear correlation between tracheostomy timing and 90-day all-cause mortality. The secondary outcomes included free days of MV, incidence of ventilator-associated pneumonia (VAP), free days of analgesia/sedation in the intensive care unit (ICU), length of stay (LOS) in the ICU, LOS in hospital, in-ICU mortality, and 30-day all-cause mortality.
A total of 1,209 patients were included in this study, of these, 163 (13.5%) patients underwent tracheostomy within 4 days after intubation, while 647 (53.5%) patients underwent tracheostomy more than 11 days after intubation. The tracheotomy timing showed a U-shaped relationship with all-cause mortality, patients who underwent tracheostomy between 5 and 10 days had the lowest 90-day mortality rate compared with patients who underwent tracheostomy within 4 days and after 11 days [84 (21.1%) vs. 40 (24.5%) and 206 (31.8%), < 0.001].
The tracheotomy timing showed a U-shaped relationship with all-cause mortality, and the risk of mortality was lowest on day 8, but a causal relationship has not been demonstrated.
评估机械通气（MV）患者气管切开时机与全因死亡率之间的关联。
这是一项回顾性队列研究。基于重症监护医学信息集市-III（MIMIC-III）数据库，选取了在同一住院期间接受气管切开的成年有创MV患者。主要结局是气管切开时机与90天全因死亡率之间的关系。采用受限立方样条分析气管切开时机与90天全因死亡率之间潜在的非线性相关性。次要结局包括MV无天数、呼吸机相关性肺炎（VAP）发生率、重症监护病房（ICU）镇痛/镇静无天数、ICU住院时间（LOS）、住院LOS、ICU内死亡率和30天全因死亡率。
本研究共纳入1209例患者，其中163例（13.5%）在插管后4天内接受气管切开，而647例（53.5%）患者在插管11天以上接受气管切开。气管切开时机与全因死亡率呈U形关系，与在4天内及11天后接受气管切开的患者相比，在5至10天接受气管切开的患者90天死亡率最低[84例（21.1%）对40例（24.5%）和206例（31.8%），<0.001]。
气管切开时机与全因死亡率呈U形关系，第8天死亡率风险最低，但尚未证实因果关系。
