目前还没有证据表明气管早期切开能改善患者预后

蓝鱼o_0

Timing of tracheostomy in critically ill patients: a meta-analysis.

Abstract

OBJECTIVE:

To compare important outcomes between early tracheostomy (ET) and late tracheostomy (LT) or prolonged intubation (PI) for critically ill patients receiving long-term ventilation during their treatment.

METHOD:

We performed computerized searches for relevant articles on PubMed, EMBASE, and the Cochrane register of controlled trials (up to July 2013). We contacted international experts and manufacturers. We included in the study randomized controlled trials (RCTs) that compared ET (performed within 10 days after initiation of laryngeal intubation) and LT (after 10 days of laryngeal intubation) or PI in critically ill adult patients admitted to intensive care units (ICUs). Two investigators evaluated the articles; divergent opinions were resolved by consensus.

RESULTS:

A meta-analysis was evaluated from nine randomized clinical trials with 2,072 participants. Compared to LT/PI, ET did not significantly reduce short-term mortality [relative risks (RR) = 0.91; 95% confidence intervals (CIs) = 0.81-1.03; p = 0.14] or long-term mortality (RR = 0.90; 95% CI = 0.76-1.08; p = 0.27). Additionally, ET was not associated with a markedly reduced length of ICU stay [weighted mean difference (WMD) = -4.41 days; 95% CI = -13.44-4.63 days; p = 0.34], ventilator-associated pneumonia (VAP) (RR = 0.88; 95% CI = 0.71-1.10; p = 0.27) or duration of mechanical ventilation (MV) (WMD = - 2.91 days; 95% CI = -7.21-1.40 days; p = 0.19).

CONCLUSION:

Among the patients requiring prolonged MV, ET showed no significant difference in clinical outcomes compared to that of the LT/PI group. But more rigorously designed and adequately powered RCTs are required to confirm it in future.

蓝鱼o_0

重症医学主委，邱海波的书《ICU主治医生手册》，里面就提到到。目前推荐的是当气管插管在7~10天时候，推荐气切。

佳蕙淼淼

症医学主委，邱海波的书《ICU主治医生手册》，里面就提到到。目前推荐的是当气管插管在7~10天时候，推荐 ...[/quote]
是呀，气管插管时间过长，VAP的发生率增加的风险会大大提高，而且患者的不适感使得尽早拔出插管成为必要。

月光依旧

管时间长改为气管切开通气，是综合的原因，与VAP的发生率增加的风险会大大提高无关（气切的风险同样大）

北施

管时间长改为气管切开通气，是综合的原因，与VAP的发生率增加的风险会大大提高无关（气切的风险同样大）同意老师的意见。主要是压迫，患者不适。