• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Neurocirugia >Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos
【24h】

Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos

机译：神经危重患者早期气管切开术及其对肺炎发生率，资源消耗和死亡率的影响分析

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Objective. We analyze the most suitable time to perform tracheostomy in neurocritically ill patients. We compare morbimortality and use of resources between those patients in which tracheostomy was done early (< 9 days) and those in which it was perform later (>9 days), in a selected group of patients. Material and methods. We made an observational prospective study involving a group of patients diagnosed as traumatic brain injury (TBI) or stroke, whose tracheostomy was performed during their stay at the Intensive Care Unit. We compared two groups: a) early tracheostomy (during first 9 days of ICU stay); b) late tracheostomy (made on 10th day or later). As variables, we studied: demographic data, severity of illness at admission, admittance department, diagnosis, length of intubation, length of mechanical ventilation (LMV), sedation and antibiotic treatment needs, ventilatorassociated pneumonia (VAP) events, ICU length of stay and mortality. We calculated relative risk of suffering from pneumonia and made a multivariate logistic regression to establish which factors were associated with an increased risk of developing pneumonia. Statistical signification p < 0.05. Results. We analyzed 118 patients, 60% with TBI. Mean length of intubation before tracheostomy was 12 days and mean LMV was 20 days. 94 VAP events were diagnosed in 81 patients (68.6%). Early tracheostomy group showed lower length of mechanical ventilation and ICU stay, lower length of sedation and antibiotic treatment, and less pneumonia events (p<0,001). The precocity of tracheostomy didn't have any influence either on hospital length of stay (p=0.844), ICU mortality (p=0.924) or in-hospital mortality (p=0.754). At the TBI group mean age was lower (p<0.001), tracheostomy was made later (p=0.026), and patients needed a longer sedation (p=0.001) and a longer antibiotic treatment (p=0.002). Length of intubation (p=0.034, OR 1.177) and ICU length of stay (p=0.003, OR 1.100) were factors independently associated with development of pneumonia. Relative risk of suffering from pneumonia when tracheostomy was made after 9 days of ICU stay was 1.55 (IC 95%: 1.10-2.16). The number needed to treat (NNT) for early tracheostomy avoiding one pneumonia event was 3.13. VAP was not associated with a higher ICU (p=0.558) or in-hospital mortality (p=0.370). Conclusions. Early tracheostomy (<9 days) provides significant advantages in neurocritically ill patients: it shortens length of mechanical ventilation and ICU stay and decreases antibiotic and sedatives requirements. Although later tracheostomy is not directly related with mortality, it increases considerably the risk of suffering from pneumonia, particularly in patients with TBI. These clinical circumstances should be evaluated individually in each patient, so the best time to perform tracheostomy in neurocritically ill patients could be established.
机译：目的。我们分析了在神经重症患者中进行气管切开术的最合适时间。我们在选定的一组患者中比较了气管切开术较早（<9天）和较晚（> 9天）进行气管切开术的患者的死亡率和资源使用情况。材料与方法。我们进行了一项观察性前瞻性研究，涉及一组诊断为外伤性脑损伤（TBI）或中风的患者，他们在重症监护病房期间进行了气管切开术。我们比较了两组：a）早期气管切开术（ICU住院的前9天）; b）晚期气管切开术（在第10天或以后进行）。作为变量，我们研究了：人口统计学数据，入院时的疾病严重程度，入学科室，诊断，插管时间，机械通气时间（LMV），镇静和抗生素治疗需求，呼吸机相关性肺炎（VAP）事件，ICU住院时间和死亡。我们计算了患肺炎的相对风险，并进行了多因素logistic回归分析，以确定哪些因素与患肺炎的风险增加有关。统计学意义p ＜0.05。结果。我们分析了118例患者，其中60％患有TBI。气管切开术前平均插管时间为12天，平均LMV为20天。在81例患者中诊断出94例VAP事件（68.6％）。早期气管切开术组的机械通气时间和ICU停留时间较短，镇静和抗生素治疗的时间较短，肺炎事件较少（p <0.001）。气管切开术的早熟对住院时间（p = 0.844），ICU死亡率（p = 0.924）或医院内死亡率（p = 0.754）都没有任何影响。在TBI组，平均年龄较低（p <0.001），较晚时进行气管造口术（p = 0.026），患者需要更长的镇静作用（p = 0.001）和更长的抗生素治疗时间（p = 0.002）。插管长度（p = 0.034，OR 1.177）和ICU住院时间（p = 0.003，OR 1.100）是与肺炎发生独立相关的因素。在ICU停留9天后进行气管切开术时患肺炎的相对风险为1.55（IC 95％：1.10-2.16）。进行早期气管切开术避免一次肺炎的治疗需要（NNT）的数量是3.13。 VAP与较高的ICU（p = 0.558）或院内死亡率（p = 0.370）无关。结论。早期气管切开术（<9天）在神经重症患者中具有显着优势：缩短了机械通气时间和ICU停留时间，并降低了抗生素和镇静剂的需求。尽管后来的气管切开术与死亡率没有直接关系，但它大大增加了患肺炎的风险，特别是在TBI患者中。这些临床情况应在每位患者中进行单独评估，以便可以确定在神经危重患者中进行气管切开术的最佳时间。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号