在多重创伤患者中,早期与晚期的气管切除术
Kelly Ansems1, Eva Steinfeld1, Nicole Skoetz2
1Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
The Cochrane database of systematic reviews
|August 6, 2025
概括
多重创伤患者的早期气管切除术可能不会显著影响死亡率或重症监护室停留,但证据仍然非常不确定. 需要进一步进行高质量的研究,以澄清益处和长期影响.
科学领域:
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 83%的创伤患者需要进入重症监护室 (ICU),许多人需要机械通风.
- 多重创伤患者气管切除术的最佳时间尚不清楚,尽管它常用于长期通风.
- 本综述解决了在重症多重创伤患者中早期与晚期气管切除术的系统评估的需要.
研究的目的:
- 评估早期气管切除术的益处和危害,与多重创伤的成年人晚期气管切除术相比.
- 系统地评估气管切除术时间对ICU环境中的关键结果的影响.
主要方法:
- 搜索了多个数据库 (CENTRAL,MEDLINE,科学网等) 在2024年3月之前.
- 包括随机对照试验 (RCT) 和非随机干预研究 (NRSI) 在重症成人多重创伤.
- 定义早期气管切除术为<10天和晚期气管切除术为≥10天后输入管,用于主要比较.
主要成果:
- 其中包括一个RCT (60名参与者) 和22名NRSI (44,811名参与者).
- 来自RCT的证据表明,早期气管切除术对死亡率,ICU住院或肺炎的影响很小或不存在,但确定性非常低.
- NRSI数据还表明对死亡率和肺炎的不确定的影响,有些人认为ICU停留时间减少,但在医院死亡率增加;证据确定性始终非常低.
结论:
- 早期气管切除术 (<10天) 可能对多重创伤患者的死亡率,ICU住院或肺炎的影响很小,但证据高度不确定.
- 没有关于生活质量和不良事件的数据;经调整的NRSI数据表明可能减少ICU停留时间.
- 需要高质量的研究来标准化定义,探索时间效应,并评估基于证据的临床决策的长期结果.
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