Luo Jiaqi, Xie Wenfeng, Hong Shuyi, Gao Jinliang, Yang Chunhua, Shi Yiming
Department of Otolaryngology, Shenzhen City Baoan District Women's and Children's Hospital, Baoan District, Shenzhen, Guangdong, China.
Intensive Care Unit, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; and Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Respir Care. 2023 Dec 28;69(1):76-81. doi: 10.4187/respcare.10837.
The timing of tracheostomy in ventilated patients remains controversial. This study aimed to compare the effect of early tracheostomy (≤7 d) with late tracheostomy (>7 d) on the prognosis of patients requiring prolonged mechanical ventilation.
This was a retrospective observational cohort study. The data of 175 patients who received tracheostomy at the ICU between January 1, 2015-July 31, 2022, were collected. Patients were excluded from the study if medical records were incomplete or they underwent tracheostomy as part of a planned operation procedure. One-to-one propensity score matching was used to correct the baseline characteristics between the early and late tracheostomy groups. The treatment process and outcomes were compared between the two groups. The primary outcome was the incidence of ventilator-associated pneumonia (VAP) between groups.
After propensity score matching, 88 subjects were included in the analysis. Compared with the late tracheostomy group, the incidence of VAP, hospital length of stay, sedation-free days, ventilator-free days, and ICU-free days were longer in the early tracheostomy group. There were no significant differences in the 90-d mortality between the two groups.
Early tracheostomy can reduce the occurrence of complications for ICU patients.
机械通气患者气管切开的时机仍存在争议。本研究旨在比较早期气管切开（≤7天）与晚期气管切开（>7天）对需要长期机械通气患者预后的影响。
这是一项回顾性观察队列研究。收集了2015年1月1日至2022年7月31日期间在重症监护病房接受气管切开的175例患者的数据。如果病历不完整或患者作为计划手术的一部分接受气管切开，则将其排除在研究之外。采用一对一倾向评分匹配法校正早期和晚期气管切开组之间的基线特征。比较两组的治疗过程和结局。主要结局是两组之间呼吸机相关性肺炎（VAP）的发生率。
倾向评分匹配后，88名受试者纳入分析。与晚期气管切开组相比，早期气管切开组的VAP发生率、住院时间、无镇静天数、无呼吸机天数和无重症监护病房天数更长。两组之间90天死亡率无显著差异。
早期气管切开可减少ICU患者并发症的发生。
