Devanand Nilesh Anand, Thiruvenkatarajan Venkatesan, Liu Wai-Man, Sirisinghe Isuru, Court-Kowalski Stefan, Pryor Lee, Gatley Anne, Sethi Sandeep, Sundararajan Krishnaswamy
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
Department of Anaesthesia, The Queen Elizabeth Hospital, SA, Australia.
J Intensive Care Soc. 2024 Mar 18;25(3):279-287. doi: 10.1177/17511437241238877. eCollection 2024 Aug.
Studies comparing percutaneous tracheostomy (PT) and surgical tracheostomy (ST) complications in the critically ill patient population with high acuity, complexity, and severity of illness are sparse. This study evaluated the outcomes of elective PT versus ST in such patients managed at a quaternary referral center.
The primary aim was to detect a difference in hospital mortality between the two techniques. The secondary aims were to compare Intensive Care Unit (ICU) mortality, complications (including stoma site, tracheostomy-related, and decannulation complications), ICU and hospital length of stay, and time to decannulation.
This was a single-center retrospective observational study of ICU admission from August 2018 to August 2021. Patients were included if an elective tracheostomy was performed during their ICU admission. Patients with a pre-existing tracheostomy and those who underwent an obligatory tracheostomy requirement (e.g. total laryngectomy) were excluded. Cohorts were matched using Hainmueller's entropy balancing. Binary data were evaluated using logistic regression and continuous data with ordinary least squares regression.
349 patients with a tracheostomy were managed in the ICU during the observation period. They were predominantly males (75% in PT; 67% in ST), with a mean age in the PT and ST group of (47; SD = 18) and (55; SD = 16), respectively. After exclusion, 135 patients remained, with 63 in the PT group and 72 in the ST group. Patients receiving ST were significantly older with a higher Body Mass Index (BMI) than the PT group. There were no significant differences in gender, Acute Physiological And Chronic Health Evaluation (APACHE) III, and the Australian and New Zealand Risk Of Death (ANZROD) between the two groups. There was no difference in hospital mortality between groups (OR 0.91, CI 0.26-3.18, = 0.88). There were also no differences in ICU mortality, ICU and hospital length of stay, and time to decannulation. PT was associated with a greater likelihood of complications (OR 4.19; 95% CI 1.73-10.13; < 0.01). PT was associated with a greater risk of complications in those who had this performed early (<10 days of intubation) as well as late (>10 days of intubation).
Percutaneous tracheostomy was associated with higher complications compared to surgical tracheostomy. They were related to tracheostomy cuff deflation, stomal site bleeding and infection, sputum plugging, and accidental and failed decannulation. These findings have identified opportunities to improve patient outcomes.
在患有高 acuity、复杂性和严重性疾病的危重病患者群体中，比较经皮气管切开术（PT）和外科气管切开术（ST）并发症的研究较少。本研究评估了在四级转诊中心接受治疗的此类患者中，择期 PT 与 ST 的结果。
主要目的是检测两种技术在医院死亡率方面的差异。次要目的是比较重症监护病房（ICU）死亡率、并发症（包括造口部位、气管切开术相关和拔管并发症）、ICU 和医院住院时间以及拔管时间。
这是一项对 2018 年 8 月至 2021 年 8 月期间入住 ICU 的患者进行的单中心回顾性观察研究。如果患者在 ICU 住院期间接受了择期气管切开术，则纳入研究。排除既往有气管切开术的患者和那些因强制性气管切开术要求（如全喉切除术）而接受手术的患者。使用 Hainmueller 的熵平衡法对队列进行匹配。使用逻辑回归评估二元数据，使用普通最小二乘法回归评估连续数据。
在观察期内，349 例气管切开术患者在 ICU 接受治疗。他们主要为男性（PT 组中占 75%；ST 组中占 67%），PT 组和 ST 组的平均年龄分别为（47 岁；标准差 = 18）和（55 岁；标准差 = 16）。排除后，剩下 135 例患者，PT 组 63 例，ST 组 72 例。接受 ST 的患者比 PT 组年龄显著更大，体重指数（BMI）更高。两组在性别、急性生理与慢性健康评估（APACHE）III 以及澳大利亚和新西兰死亡风险（ANZROD）方面无显著差异。两组在医院死亡率方面无差异（比值比 0.91，可信区间 0.26 - 3.18，P = 0.88）。在 ICU 死亡率、ICU 和医院住院时间以及拔管时间方面也无差异。PT 与更高的并发症发生率相关（比值比 4.19；95%可信区间 1.73 - 10.13；P < 0.01）。PT 在早期（插管<10 天）以及晚期（插管>10 天）进行的患者中与更高的并发症风险相关。
与外科气管切开术相比，经皮气管切开术的并发症更高。它们与气管切开术套管放气、造口部位出血和感染、痰液堵塞以及意外和拔管失败有关。这些发现为改善患者结局提供了机会。
