Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan.
Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan.
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与气管切开时机和呼吸机脱机相关的因素：来自台湾北部人群的调查结果。
DOI：
10.1111/crj.12492
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Hsu,Min-Tao
中科院分区：
文献类型：
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作者：
Chen,Hui-Chin;Song,Lixin;Chang,Hsin-Chieh;Hsu,Min-Tao
目的探讨影响气管切开时机及呼吸机撤机的因素，并描述呼吸机撤机失败患者的过渡护理安置。方法采用回顾性设计，通过对台湾北部一家医院的病历回顾，收集2年来的数据。60名在重症监护病房(ICU)或呼吸监护中心接受气管切开术的患者入选。数据包括每个患者的人口统计信息、疾病诊断、格拉斯哥昏迷评分和急性生理学和慢性健康评估II评分。结果在ICU使用呼吸机的患者，气管造口率为2.7%。早期(21天内)和晚期(21天内)气管切开术分别占36.7%和63.3%。在接受气管切开术的患者中，36.7%的患者经历了呼吸机脱机。影响气管切开时机的因素有疾病诊断(P= 0.036)和呼吸机使用天数(P= 0.003)。与撤机相关的因素有疾病诊断(P= 0.010)和气管切开时机(P= 0.001)。早期气管切开导致呼吸机脱机的概率是晚期气管切开的10.9倍(95%CI=2.5~47.7，P= 0.002)。早期气管切开撤机成功率较高。手术患者更有可能接受早期气管切开术。然而，台湾接受气管切开术的患者数量低于其他国家。进一步的研究可能需要了解患者接受气管切开术的文化差异。
IntroductionDetermining the optimal time for performing a tracheostomy and weaning a patient off a ventilator is typically challenging for physicians, respiratory therapists, patients and patients' families.PurposeThis study examined the factors influencing tracheostomy timing and ventilator weaning and described the transition‐care placement of patients who experience unsuccessful ventilator weaning.MethodsA retrospective design was employed, and 2 years of data were collected through a medical chart review performed at a hospital in Northern Taiwan. Sixty patients who received tracheostomies in the intensive care unit (ICU) or respiratory care center were enrolled. The data included each patient's demographic information, disease diagnosis, and Glasgow Coma Scale score and Acute Physiology and Chronic Health Evaluation II scores.ResultsFor patients on a ventilator in an ICU, the tracheostomy rate was 2.7%. Early (within 21 days) and late (>21 days) tracheostomies accounted for 36.7% and 63.3%, respectively. Of the patients who had received tracheostomies, 36.7% experienced ventilator weaning. The factors related to tracheostomy timing were disease diagnosis (P= 0.036) and days of ventilator use (P= 0.003). The factors related to ventilator weaning included disease diagnosis (P= 0.010) and tracheostomy timing (P= 0.001). Early tracheostomies were 10.9 times more likely than late tracheostomies to result in ventilator weaning (95%CI =2.5–47.7,P= 0.002).ConclusionsTracheostomy timing was strongly correlated with ventilator weaning. Early tracheostomy was higher successful ventilator weaning rates. The surgical patients were more likely to receive an early tracheostomy. However, the number of patients in Taiwan who received tracheostomies was lower than that in other countries. Further study maybe need to understand cultural variations in the acceptance of tracheostomies by patients.