气管切开时机与呼吸机相关性肺炎风险无关（全文在5楼）

蓝鱼o_0

JAMA. 2010 Apr 21;303(15):1483-9. doi: 10.1001/jama.2010.447.

Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial.

Terragni PP, Antonelli M, Fumagalli R, Faggiano C, Berardino M, Pallavicini FB, Miletto A, Mangione S, Sinardi AU, Pastorelli M, Vivaldi N, Pasetto A, Della Rocca G, Urbino R, Filippini C, Pagano E, Evangelista A, Ciccone G, Mascia L, Ranieri VM.

Source

Anestesia e Rianimazione 1, Ospedale S. Giovanni Battista, Università di Torino, Turin, Italy.

Abstract

CONTEXT:

Tracheotomy is used to replace endotracheal intubation in patients requiring prolonged ventilation; however, there is considerable variability in the time considered optimal for performing tracheotomy. This is of clinical importance because timing is a key criterion for performing a tracheotomy and patients who receive one require a large amount of health care resources.

OBJECTIVE:

To determine the effectiveness of early tracheotomy (after 6-8 days of laryngeal intubation) compared with late tracheotomy (after 13-15 days of laryngeal intubation) in reducing the incidence of pneumonia and increasing the number of ventilator-free and intensive care unit (ICU)-free days.

DESIGN, SETTING, AND PATIENTS:

Randomized controlled trial performed in 12 Italian ICUs from June 2004 to June 2008 of 600 adult patients enrolled without lung infection, who had been ventilated for 24 hours, had a Simplified Acute Physiology Score II between 35 and 65, and had a sequential organ failure assessment score of 5 or greater.

INTERVENTION:

Patients who had worsening of respiratory conditions, unchanged or worse sequential organ failure assessment score, and no pneumonia 48 hours after inclusion were randomized to early tracheotomy (n = 209; 145 received tracheotomy) or late tracheotomy (n = 210; 119 received tracheotomy).

MAIN OUTCOME MEASURES:

The primary endpoint was incidence of ventilator-associated pneumonia; secondary endpoints during the 28 days immediately following randomization were number of ventilator-free days, number of ICU-free days, and number of patients in each group who were still alive.

RESULTS:

Ventilator associated pneumonia was observed in 30 patients in the early tracheotomy group (14%; 95% confidence interval [CI], 10%-19%) and in 44 patients in the late tracheotomy group (21%; 95% CI, 15%-26%) (P = .07). During the 28 days immediately following randomization, the hazard ratio of developing ventilator-associated pneumonia was 0.66 (95% CI, 0.42-1.04), remaining connected to the ventilator was 0.70 (95% CI, 0.56-0.87), remaining in the ICU was 0.73 (95% CI, 0.55-0.97), and dying was 0.80 (95% CI, 0.56-1.15).

CONCLUSION:

Among mechanically ventilated adult ICU patients, early tracheotomy compared with late tracheotomy did not result in statistically significant improvement in incidence of ventilator-associated pneumonia.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00262431.

蓝鱼o_0

意大利都灵大学Terragni的随机对照试验证实，气管切开的时机似乎不影响呼吸机相关性肺炎风险。（JAMA.2010,303:1483）

        研究者从意大利12家ICU入组2004~2008年无肺部感染的****患者（简化急性躯体评分Ⅱ35~65分，序贯器官衰竭评分≥5分），随机分为早期组（n=209，预计气管插管后6~8 d切开）与晚期组（n=210，预计气管插管后13~15 d切开。

        结果显示，早期组和晚期组分别有145例和119例患者接受气管切开；4周时早期组和晚期组呼吸机相关性肺炎发生率分别为14%和21%（HR=0.66，P=0.07）；与晚期组相比，早期组在呼吸机维持、住ICU时间及死亡这3项指标上，HR分别为0.70、0.73和0.80。

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鬼才

文献 ，希望把原文挂出来，大家分享。

蓝鱼o_0

鬼才 发表于 2013-11-12 21:16

                               
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好文献 ，希望把原文挂出来，大家分享。

哎，总是逼我拿出私人珍藏。

鬼才

，总是逼我拿出私人珍藏。[/quote]
呵呵，釜底抽薪，不好意思了。好文献大家交流，为人民服务。谢谢了。

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