在严重受伤的烧伤幸存者中,早期与晚期气管切除术:全国性的多数据库分析
Jennifer K Shah1,2, Eloise W Stanton3, Daniel Najafali4
1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
概括
在需要长时间机械通风的烧伤患者中,早期气管切除与更短的住院时间和更少的呼吸机日有关. 这项研究分析了国家数据,以支持重症烧伤幸存者及时进行气管切除术.
科学领域:
- 临界护理医学 临界护理医学
- 烧伤手术 烧伤手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 气管切除术对于需要长期机械通风的重症患者来说是一个至关重要的手术.
- 在烧伤患者中进行气管切除术的最佳时间仍然是调查的主题.
研究的目的:
- 评估早期与晚期气管切除术之间的关联以及烧伤幸存者的患者结果.
- 确定早期气管切除术是否会减少停留时间 (LOS) 和呼吸机相关肺炎 (VAP).
主要方法:
- 分析了三个国家数据库 (NIS,NTDB,BCQP),其中包括9173名经过气管切除术的烧伤患者.
- 患者的分层分为早期 (≤10天) 和晚期 (>10天) 气管切除组.
- 倾向性得分匹配用于比较结果,包括LOS,ICU LOS,呼吸机日,VAP和排放配置.
主要成果:
- 在所有数据库中,早期气管切除术与显著较短的整体LOS有关.
- 在NTDB和BCQP队列中观察到较短的ICU LOS和较少的呼吸器日与早期气管切除术.
- 早期气管切除术没有显著影响VAP率或出院到住院康复,但在NTDB和BCQP中减少了LTAC出院.
结论:
- 严重受伤烧伤患者的早期气管切除术需要长时间的机械通风,多个数据库的证据支持这一说法.
- 这些发现表明,及时的气管切除术可以优化资源利用和患者恢复轨迹.
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