Risk factors for tracheostomy requirement in extremely low birth weight infants
Risk factors for tracheostomy requirement in extremely low birth weight infants
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DOI：
10.1080/14767058.2017.1287895
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发表时间：
2018-01-01
影响因子：
1.8
通讯作者：
Bhandari, Vineet
中科院分区：
文献类型：
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作者：
Levit, Orly L.;Shabanova, Veronika;Bhandari, Vineet
目的：确定影响极低出生体重儿（ELBW）人群气管切开术风险的变量。方法：进行回顾性配对病例对照研究。将气管切开的ELBW婴儿与未进行气管切开的对照组进行比较。数据收集包括人口统计学、每次插管和拔管尝试的详细信息、类固醇的使用和合并症的存在。统计分析包括条件Logistic回归和Poisson回归聚类observations.Results：28 ELBW婴儿气管造口术确定。病例组和对照组的平均胎龄均为25周（22-29），67.9%为男性。平均在118天（95%CI：107-128）进行气管切开术，气管切开术时体重为2877 g（95%CI：2657-3098）。在最终模型中，使用气管插管（ETT）的累积天数和插管事件总数与气管切开术相关。每增加一天的插管，气管切开的几率增加11%（OR=1.11，95%CI：1.01，1.23），每次新的插管事件/拔管失败事件，气管切开术的几率比前一次事件增加150%结论：气管切开术的气管插管次数和ETT通气的累积暴露量越大，气管切开术的发生率越高。
Aim: To identify variables that affect the risk of tracheostomy in a population of extremely low birth weight (ELBW) infants.Methods: A retrospective matched case-control study was conducted. ELBW infants with a tracheostomy were compared with controls without tracheostomy. Data collection included demographics, detailed information about each intubation and extubation attempt, the use of steroids and the presence of comorbidities. Statistical analyses include conditional logistic regression and Poisson regression for clustered observations.Results: Twenty-eight ELBW infants with a tracheostomy were identified. Mean gestational age for both cases and controls was 25 weeks (22-29) and 67.9% were males. Tracheostomy was performed on average on day of life 118 (95%CI: 107-128) and weight at tracheostomy was 2877g (95%CI: 2657-3098). In the final model, cumulative days with an endotracheal tube (ETT) and total number of intubation episodes were associated with a tracheostomy. For each additional day of intubation, odds of tracheostomy increased by 11% (OR=1.11, 95%CI: 1.01, 1.23) and with each new intubation episode/failed extubation episode, odds of tracheostomy increased by 150% from the previous episode (OR=2.5, 95%CI: 1.2, 5.2).Conclusions: Greater cumulative exposure to ETT ventilation and number of intubations is associated with having a tracheostomy.