目的:危重患者机械通气(MV)气管造口术的时机是一个有争议的话题。我们的目标是确定接受MV的患者进行气管切开术的最合适时机。
方法:回顾性队列研究。
方法:从2011年1月至2020年12月,中国一家三甲医院接受了气管切开术的一千八百八十四家医院。
方法:气管造口术时机分为三组:早期气管造口术(ET),中间气管造口术(IMT),和晚期气管造口术(LT),基于从气管插管到气管切开的持续时间。我们建立了两个标准来对气管造口术的时间进行分类以进行数据分析:标准I(ET≤5天,5天10天)和标准II(ET≤7天,7天14天)。ICU停留时间等参数,住院时间,和MV持续时间用于评估结果。此外,结果被归类为良好预后,预后不良,和根据出院方式的死亡。学生t检验,方差分析(ANOVA),Mann-WhitneyU测试,Kruskal-Wallis测试,卡方检验,和Fisher的精确检验被用于评估ET之间的人口统计学数据和个体特征的差异,IMT,和LT组。单变量Cox回归模型和多变量Cox比例风险回归模型用于确定延迟气管造口术是否会增加死亡风险。
结果:在两个标准中,延迟气管切开术的患者住院时间较长(p<0.001),ICU入住(p<0.001),接收MV的总时间(p<0.001),气管造口术前接受MV的时间(p<0.001),气管造口术后接受MV的时间(p<0.001),和镇静持续时间。在被诊断为创伤的亚人群中也发现了类似的结果,神经源性或消化系统疾病。多项Logistic回归确定LT与不良预后独立相关,而ET与IMT相比没有临床益处。
结论:在混合ICU人群中,延迟气管造口术延长了ICU和住院时间,镇静持续时间,和时间接收MV。多项logistic回归分析确定延迟的气管造口术与较差的预后独立相关。
背景:ChiCTR2100043905。2021年3月5日注册。http://www。chictr.org.cn/listbycreater。aspx.
OBJECTIVE: The timing of tracheostomy for critically ill patients on mechanical ventilation (MV) is a topic of controversy. Our objective was to determine the most suitable timing for tracheostomy in patients undergoing MV.
METHODS: Retrospective cohort study.
METHODS: One thousand eight hundred eighty-four hospitalisations received tracheostomy from January 2011 to December 2020 in a Chinese tertiary hospital.
METHODS: Tracheostomy timing was divided into three groups: early tracheostomy (ET), intermediate tracheostomy (IMT), and late tracheostomy (LT), based on the duration from tracheal intubation to tracheostomy. We established two criteria to classify the timing of tracheostomy for data analysis: Criteria I (ET ≤ 5 days, 5 days < IMT ≤ 10 days, LT > 10 days) and Criteria II (ET ≤ 7 days, 7 days < IMT ≤ 14 days, LT > 14 days). Parameters such as length of ICU stay, length of hospital stay, and duration of MV were used to evaluate outcomes. Additionally, the outcomes were categorized as good prognosis, poor prognosis, and death based on the manner of hospital discharge. Student\'s t-test, analysis of variance (ANOVA), Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, and Fisher\'s exact test were employed as appropriate to assess differences in demographic data and individual characteristics among the ET, IMT, and LT groups. Univariate Cox regression model and multivariable Cox proportional hazards regression model were utilized to determine whether delaying tracheostomy would increase the risk of death.
RESULTS: In both of two criterion, patients with delayed tracheostomies had longer hospital stays (p < 0.001), ICU stays (p < 0.001), total time receiving MV (p < 0.001), time receiving MV before tracheostomy (p < 0.001), time receiving MV after tracheostomy (p < 0.001), and sedation durations. Similar results were also found in sub-population diagnosed as trauma, neurogenic or digestive disorders. Multinomial Logistic regression identified LT was independently associated with poor prognosis, whereas ET conferred no clinical benefits compared with IMT.
CONCLUSIONS: In a mixed ICU population, delayed tracheostomy prolonged ICU and hospital stays, sedation durations, and time receiving MV. Multinomial logistic regression analysis identified delayed tracheostomies as independently correlated with worse outcomes.
BACKGROUND: ChiCTR2100043905. Registered 05 March 2021. http://www.chictr.org.cn/listbycreater.aspx.