Faculty of Medicine, Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, 50-556, Poland.
Clinic of Anesthesiology and Intensive Therapy, University Hospital in Wroclaw, Wroclaw, 50-556, Poland.
Sci Rep. 2024 Nov 27;14(1):29472. doi: 10.1038/s41598-024-81115-5.
Tracheostomy can reduce mechanical ventilation (MV) duration, ICU and hospital length of stay (LOS), and ventilator-associated pneumonia (VAP) risk in critically ill patients. The timing of tracheostomy in COVID-19 patients has been studied, but its impact on VAP incidence has rarely been analyzed. This study investigated tracheostomy timing's impact on VAP incidence, ventilation time, ICU and hospital LOS, and mortality in critically ill COVID-19 patients. It was conducted at the University Hospital in Wroclaw, Poland, from October 1, 2020, to June 30, 2021. Of 60 tracheostomized patients, 21 (35%) developed VAP. Early tracheostomy (≤ 13 days) resulted in 8/42 (19%) VAP cases, while late tracheostomy (> 13 days) had 13/18 (72%) VAP cases, showing a significantly lower VAP risk in the early group (p < 0.05). VAP incidence rates were 7.9 and 22.8 per 1000 patient-days for early and late groups, respectively. Early tracheostomy patients had shorter median MV duration (18 vs. 33 days, p < 0.05), ICU LOS (20 vs. 31 days, p < 0.05) and hospital LOS (25 vs. 47 days, p < 0.05). Early tracheostomy in critically ill COVID-19 patients significantly reduced VAP risk, MV duration, ICU, and hospital LOS.
气管切开术可以降低机械通气（MV）时间、重症监护病房（ICU）和住院时间（LOS）以及呼吸机相关性肺炎（VAP）的风险。COVID-19 患者的气管切开术时机已经得到研究，但很少分析其对 VAP 发生率的影响。本研究调查了气管切开术时机对 COVID-19 重症患者 VAP 发生率、通气时间、ICU 和住院 LOS 以及死亡率的影响。该研究在波兰弗罗茨瓦夫大学医院进行，时间为 2020 年 10 月 1 日至 2021 年 6 月 30 日。在 60 例接受气管切开术的患者中，有 21 例（35%）发生了 VAP。早期气管切开术（≤13 天）导致 8/42（19%）例 VAP，而晚期气管切开术（>13 天）导致 13/18（72%）例 VAP，早期组的 VAP 风险明显较低（p<0.05）。早期和晚期组的 VAP 发生率分别为每 1000 患者日 7.9 和 22.8 例。早期气管切开术患者的 MV 持续时间中位数（18 天比 33 天，p<0.05）、ICU LOS（20 天比 31 天，p<0.05）和住院 LOS（25 天比 47 天，p<0.05）均更短。COVID-19 重症患者的早期气管切开术可显著降低 VAP 风险、MV 持续时间、ICU 和住院 LOS。
