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首页> 外文期刊>Surgical Neurology International >Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients
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Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients

机译：孤立性重型颅脑损伤患者早期气管切开术的临床结果和成本效益

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Background: Early tracheostomy (ET) has been shown to be effective in reducing complications associated with prolong mechanical ventilation. The study was carried out to evaluate the role of ET in reducing the duration of mechanical ventilation, duration of intensive care unit (ICU) stay, ICU-related morbidities, and its overall effect on outcome, in patients with isolated severe traumatic brain injury (TBI). Methods: This 7-year review included 100 ICU patients with isolated severe TBI requiring mechanical ventilation. ET was defined as tracheostomy within 7 days of TBI, and prolonged endotracheal intubation (EI) as EI exceeding 7 days of TBI. Of 100 patients, 49 underwent ET and 51 remained on prolong EI for ventilation. All patients were comparable in term of age and initial Glasgow Coma Scale (GCS). We evaluated groups regarding clinical outcome in terms of ventilator-associated pneumonia (VAP), ICU stay, and Glasgow Outcome Score (GOS). Results: The frequency of VAP was higher in EI group relative to ET group (63% vs. 45%, P value 0.09). ET group showed significantly less ventilator days (10 days vs. 13 days, P value 0.031), ICU stay (11 days vs. 13 days, P value 0.030), complication rate (14% vs. 18%), and mortality (8.2% vs. 17.6%). Clinical outcome assessed on the basis of GOS was also better in the ET group. Total inpatient cost was also considerably less (USD $8027) in the ET group compared with the EI group (USD $9961). Conclusions: In patients with severe TBI, ET decreases total days of ventilation and ICU stay, and is associated with a decrease in the frequency of VAP. ET should be considered in severe head injury patients requiring prolong ventilatory support.
机译：背景：早期气管切开术（ET）已被证明可有效减少与延长机械通气相关的并发症。这项研究旨在评估ET在孤立性严重脑外伤患者中减少机械通气时间，重症监护病房（ICU）住院时间，ICU相关发病率及其对预后的总体影响的作用（ TBI）。方法：这项为期7年的回顾性研究包括100例ICU患者，这些患者患有孤立的重度TBI，需要机械通气。 ET被定义为TBI在7天之内进行气管切开术，延长气管插管（EI）是EI超过TBI 7天。在100例患者中，有49例接受了ET，而51例仍接受了延长的EI进行通气。所有患者在年龄和初始格拉斯哥昏迷量表（GCS）方面均具有可比性。我们根据呼吸机相关性肺炎（VAP），ICU停留时间和格拉斯哥结果评分（GOS）评估了有关临床结局的组。结果：EI组的VAP频率高于ET组（63％比45％，P值0.09）。 ET组的呼吸机天数显着减少（10天vs. 13天，P值0.031），ICU停留时间（11天vs. 13天，P值0.030），并发症发生率（14％vs. 18％）和死亡率（8.2） ％vs. 17.6％）。在ET组中，基于GOS评估的临床结果也更好。与EI组（9961美元）相比，ET组的总住院费用也要少得多（8027美元）。结论：在患有严重TBI的患者中，ET减少了通气和ICU停留的总天数，并与VAP频率降低相关。需要长期通气支持的严重颅脑损伤患者应考虑ET。

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