O'Shea Thomas F, Franko Lynze R, Paneitz Dane C, Shelton Kenneth T, Osho Asishana A, Auchincloss Hugh G
Boston University School of Medicine, Boston, Mass.
Department of Surgery, Massachusetts General Hospital, Boston, Mass.
JTCVS Open. 2024 Feb 7;18:138-144. doi: 10.1016/j.xjon.2024.02.003. eCollection 2024 Apr.
We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements.
A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score.
Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) ( = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; < .001) and sedative infusions (62.1% [n = 36] pre vs 27.6% [n = 16] post; < .001). The percent of patients on active mechanical ventilation did not differ.
The median vasoactive-inotrope score in cardiac surgery patients with prolonged mechanical ventilation was significantly reduced after tracheostomy placement. There was also a significant reduction in the number of patients on vasoactive/inotropic and sedative infusions 3 days after tracheostomy. These data suggest that tracheostomy has a positive effect on the hemodynamic stability of patients after cardiac surgery and should be considered to facilitate postoperative recovery.
我们试图量化气管切开术对术后仍有持续通气需求的心脏手术患者血流动力学稳定性的影响。
对2018年至2022年接受气管切开术的术后长期机械通气的心脏手术患者进行回顾性、单中心观察性分析。如果患者接受机械循环支持或在气管切开术前后3天出现无关的严重并发症，则将其排除。使用血管活性药物-正性肌力药物评分来量化血管活性药物和正性肌力药物的需求。
共识别出61例患者，其中58例符合纳入标准。气管切开术前3天与术后3天相比，血管活性药物-正性肌力药物评分中位数从3.35天（四分位间距，0-8.79）降至0天（四分位间距，0-7.79天）（P=0.027）。这种趋势的图表显示在气管切开术时出现明显的转折点。此外，气管切开术后，接受血管活性/正性肌力药物输注的患者减少（术前67.2% [n=39]，术后24.1% [n=14]；P<0.001），接受镇静药物输注的患者也减少（术前62.1% [n=36]，术后27.6% [n=16]；P<0.001）。接受有创机械通气的患者百分比无差异。
长期机械通气的心脏手术患者在气管切开术后血管活性药物-正性肌力药物评分中位数显著降低。气管切开术后3天，接受血管活性/正性肌力药物和镇静药物输注的患者数量也显著减少。这些数据表明气管切开术对心脏手术后患者的血流动力学稳定性有积极影响，应考虑采用以促进术后恢复。
