Effect of early tracheostomy on clinical outcomes in critically ill lung transplant recipients
Effect of early tracheostomy on clinical outcomes in critically ill lung transplant recipients
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DOI：
10.1007/s11748-018-0949-3
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发表时间：
2018-09-01
影响因子：
1.2
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
--
作者：
Miyoshi, Ryo;Chen-Yoshikawa, Toyofumi F.;Date, Hiroshi
目的本研究的目的是评估早期气管切开术在肺移植患者中的效果，并确定其最佳时机和对临床结局的影响。方法我们回顾性分析了2008年8月至2016年1月期间在我们机构接受肺移植的96例成人患者的记录。时间气管切开术是根据时间的程序定义：“早期”，如果不到3天或“晚”，如果3天或3天以上的肺transplantation.Results后49例（51%）进行气管切开术3.2 +/- 1.8天后肺移植。早期气管切开21例（42.9%），晚期气管切开28例（57.1%）。多变量Logistic回归分析表明，术前体能状态是气管切开术的重要预测因素（p = 0.006，比值比2.72）。与晚期气管切开组相比，早期气管切开组的患者更早开始行走（p = 0.003）和经口进食（p = 0.0006），机械通气时间更短（p = 0.04），重症监护室时间更短（p = 0.01），住院时间更短（p = 0.04）。术后行走无显著差异（p = 0.06），经口喂养（p = 0.17）或住院时间（p = 0.37）结论肺移植术后早期气管切开可减少重症监护和住院时间，这是由于术后恢复良好，即使对于术前条件较差的患者也是如此。此外，早期气管切开患者的住院时间与肺移植后未行气管切开的患者相似。
Objectives The purpose of this study was to evaluate the effect of early tracheostomy in patients following lung transplantation and to determine its optimal timing and influence on clinical outcomes.Methods We retrospectively reviewed records of 96 adult patients who underwent lung transplantation at our institution between August 2008 and January 2016. Time-to-tracheostomy was defined based on timing of the procedure: "early" if less than 3 days or "late" if 3 or more days after lung transplantation.Results Forty-nine patients (51%) underwent tracheostomy 3.2 +/- 1.8 days after lung transplantation. Among these patients, 21 patients (42.9%) underwent early tracheostomy and 28 patients (57.1%) underwent late tracheostomy. Multivariable logistic regression analysis indicated that preoperative performance status was a significant predictor for tracheostomy (p = 0.006, odds ratio 2.72). Patients in the early tracheostomy group began walking (p = 0.003) and oral feeding (p = 0.0006) earlier and had a shorter duration of mechanical ventilation (p = 0.04) and shorter length of intensive care unit (p = 0.01) and hospital stay (p = 0.04) than patients in the late tracheostomy group. No significant differences in postoperative walking (p = 0.06), oral feeding (p = 0.17), or length of hospital stay (p = 0.37) were observed between patients who underwent early tracheostomy and those who did not undergo tracheostomy.Conclusions Early tracheostomy following lung transplantation decreased both intensive care and hospital stay, due to improved postoperative recovery, even in patients with poor preoperative conditions. Furthermore, length of hospital stay in patients with early tracheostomy was similar to that of patients without tracheostomy after lung transplantation.