气管切除术与中度至重度创伤性脑损伤的长时间输管治疗:一个多中心的回顾性队列研究
Noémie Villemure-Poliquin1,2, Olivier Costerousse1, Paule Lessard Bonaventure1,3
1CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, QC, Canada.
概括
在中度至重度创伤性脑损伤 (TBI) 患者的气管切除术显著降低了30天的死亡率,相比于长期内管道输管. 早期的气管切除术可能会缩短呼吸支的持续时间,但不会影响死亡率.
科学领域:
- 关键护理医学 关键护理医学
- 神经外科 神经外科
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 气管切除术经常在重症监护室 (ICU) 进行,患者中度至重度的创伤性脑损伤 (TBI) 需要长时间的机械通风.
- 支持TBI患者早期气管切除术的证据有限,这促使进一步调查其益处与长期内内管管道输入相比.
研究的目的:
- 在中度至重度TBI患者中,评估气管切除术与延长的内内管管道输入相比,气管切除术的临床益处.
- 为了确定气管切除术的时间是否会影响患者的治疗结果.
主要方法:
- 一个回顾性多中心队列研究,使用北克创伤登记 (2013-2019).
- 纳入标准:成人TBI患者 (格拉斯哥昏迷尺度<13) 需要机械通风≥96小时.
- 主要结局:30天死亡率. 二次结局包括ICU/医院死亡率,六个月死亡率,通风持续时间,VAP和停留时间. 使用了倾向得分调整和考克斯共享脆弱模型.
主要成果:
- 气管切除术与30天死亡率显著降低有关 (aHR为0.33),与长期内管道输入相比.
- 这种死亡益处扩展到ICU和六个月的随访.
- 虽然气管切除术增加了机械通风的持续时间,但它没有增加住院或重症监护室停留时间. 早期的气管切除术与更短的呼吸支和住院/ICU停留时间有关.
结论:
- 气管切除术与中度至重度TBI患者的死亡率降低有关,与长时间内管道输入相比.
- 气管切除术的时间 (早期与晚期) 并没有影响死亡率,尽管早期的手术可能会减少通风和住院/ICU的时间.
- 潜在的剩余时间依赖性指示偏差可能会限制研究结果的概括性.
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