9.8 vs p vs p vs 29.7% p= % vs % p=0.178

Size: px

Start display at page:

Download "9.8 vs p vs p vs 29.7% p= % vs % p=0.178"

Christopher Hawkins
5 years ago
Views:

1 , *, ** ICU vs p vs p vs 29.7% p= % vs % p= see1000see1000@yahoo.com.tw * ** 100

2 tracheomalacia stenosis 2 retrospective observational cohort APACH score Tiss ( ) 3 ( ) ( ) RCW early tracheostomy 14 late tracheostomy 50% PEEP 8 cmh2o SaO2 90% PSV 10 cmh2o 5-8 ml/kg T T-piece 35 / 90% % PS10 101

3 PSV T RCW SPSS13.0 ICU chi-square t test 14 ICU chi-square t-test ICU P< % % ICU APACHE score Tiss % 33.6% 32.8% % % % % % APACHE score Tiss % % % DOA

4 14 N=80 14 N= % % P= % % P= % * % P< % * % * P< * P< * P< APACHE score P=0.129 Tiss P= % % P= % * % P= % * % P=0.007 t-test P<

5 APACHE score Tiss ICU vs p vs p % vs.29.7% p= % vs. 57.9% P= % vs. 12.4% p=0.178 APACHE score vs vs P < Francois Blot 48% 95% % Heffner N=24 14 N= % % P= % % P=0.867 APACHE score P= * P< * P=0.002 t-test P<

6 , , 14,15 Bouderka MA Mecker G et.al Yaseen Arabi et.al % % 7 H. Flaatten et.al % % 6 Alan D.Brook et.al % % 10 Mark J.Rumbak et.al % % Chia-Lin Hsu et.al * % * % 21 * 105

7 15 16 Ely Justin L Chin-Lin Hsu Chien-Tung Chin % vs. 29.7% 38.8% vs. 56.8% vs Davis 20 BICRO vs cmh2o/l vs J/L CC auto-peep

8 26 27 Ciaglia 28, 01. Paolo Pelosi, Paolo; Severgnini, Paolo.Tracheostomy must be individualized! Critical Care 2004;8: Stauffer J. Complications of endotracheal intubation and tracheostomy. Respir Care 1999;44: J Michael Jaeger, Keith A Littlewood, Charles G Durbin Jr The Role of Tracheal Ventilation Respir Care 2002; 47: Blot,F.& Melot, C., et al. Indications, timing, and techniques of tracheostomy in 152 French ICUs Chest 2005;127: Heffner, JE. Timing of trachostony in ventilator dependent patient. Clin Chest Med 1991;12: Heffner J. Timing of tracheotomy in mechanically ventilated patients. Am Rev Respir Dis 1993;147: Pierson DJ.Tracheostomy and weaning. Respir Care 2005;50: Moller MG, Slaikeu JD, Bonelli P, Davis AT, Hoogeboom JE, Bonnell BW.Early tracheostomy versus late tracheostomy in the surgical intensive care unit. The American Journal of Surgery, 189, Issue 3, P Arabi Y, Haddad S, Shirawi N, Al Shimemeri AEarly tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care 2004;8:R347-R Flaatten H, Gjerde S, Heimdal JH, Aardal S. The effect of tracheostomy on outcome in intensive care unit patients. Acta Anaesthesiol Scand 2006;50: Brook AD, Sherman G, Malen J, Kollef MH. Early versus late tracheostomy in patients who require prolonged mechanical ventilation. Am J Crit Care 2000;9: Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A Prospective, Randomized, Study Comparing Early Percutaneous Dilational Tracheotomy to Prolonged Translaryngeal Intubation (Delayed Tracheotomy) in Critically Ill Medical Patients. 107

9 Crit Care Med 2004;32: Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC.Timing of Tracheostomy as a Determinant of Weaning Success in Critically Ill Patients: A Retrospective. Study Crit Care 2005;9:R46-R Chintamani, Khanna J, Singh JP, Kulshreshtha P, Kalra P, Priyambada B, Mohil RS, Bhatnagar D. Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country--a prospective study. BMC Emerg Med 2005;14: Bouderka MA, Fakhir B, Bouaggad A, Hmamouchi B, Hamoudi D, Harti A. Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma Inj Infect and Crit Care 2004;57: Jackie H Boynton, Kenneth Hawkins, Brian J Eastridge et al. Tracheostomy timing and the duration of weaning in patients with acute respiratory failure. Critical Care 2004;8:R261-R Chiu CT, Chung YH, Lu HI, Lin MC.Weaning of longterm mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy. Chang Gung Med J 2005;28: Fernando Frutos-Vivar, Andres Esteban, Carlos Apezteguia et al. Outocome of mechanically ventilated patients who require a tracheostomy. Crit care Med 2005;33: Ranes JL, Gordon SM, Chen P,Fatica C, Hammel J, Gonzales JP, Arroliga AC. Predictors of long-term mortality in patients with ventilator-associated pneumonia. Am J Med 2006;119:897.e Nseir S, Pompeo CD, Jozefowicz E, Cavestri B, Brisson H, Nyunga M, Soubrier S, Durocher A. Relationship between tracheotomy and ventilator-associated pneumonia: a case-control study. Eur Respir J 2006; 26:[Epub ahead of print]. 21. Ely EW, Baker AM, Evans GW, Haponik EF: The prognostic significance of passing a daily screen of weaning parameters. Intensive Care Med 1999;25: Jaeger JM, Littlewood KA, Durbin CG JrThe role of tracheostomy in weaning from mechanical ventilation. Respir Care 2002;47: Kress JP, Pohlman A, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: Davis K Jr, Campbell RS, Johannigman JA, Valente JF, Branson RD. Changes in Respiratory Mechanics After Tracheostomy. Arch Surg 1999;134: Lin MC, Huang CC, Yang CT, Tsai YH, Tsao TC. Pulmonary mechanics in patients with prolonged mechanical ventilation requiring tracheostomy. Anaesth Intensive Care 1999;27: Durbin CG Jr. Early complications of tracheostomy. Respir Care 2005;50: Epstein SK Late complications of tracheostomy. Respir Care 2005;50: Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and metaanalysi. Crit Care 2006;10:R

10 THE OUTCOME OF EARLY TRACHEOSTOMY VERSUS LATE TRA- CHEOSTOMY PATIENTS IN A RESPIRATORY CARE CENTER Chun-Yi Lee, Yan-Ju Lin*, Min-Hsueh Weng** Abstract Objection: To compare the clinical outcome of early ( 14 day) versus late ( 14 day) tracheostomy in patients who intubation (after tracheostomy) required mechanical ventilation. Methods: This is a retrospective study. From January to December 2005, we retrospectively collected data from patients received intubation after tracheostomy with mechanical ventilation support in a RCC. Their outcome including: ICU length of stay, ventilator day, ventilator weaning success and failure rate. mortality rate. Results: The total of 265 patients with mechanical ventilation were enrolled. The mean ( SD) duration of mechanical ventilation was days. ICU of stay was significantly lower in the early tracheostomy than in the late tracheostomy ( vs day, p ). The duration of mechanical ventilation late tracheostomy higher than early tracheostomy ( vs day, p ). In addition the rate of ventilator weaning failure higher in the late tracheostomy higher than early tracheostomy patients (14.7% vs. 11.4%, respectively). However, mortality rate in the late tracheostomy patients higher than early tracheostomy group (18.7% vs. 12.4%, p=0.178) but showed no statistical significance. Conclusions: Early tracheostomy patients is associated with shorter length ICU stay and hasten liberation mechanical ventilation. It can reduce the overall duration of MV. The late tracheostomy patients had higher incidences of ventilator weaning failure rate and mortality rate higher than early tracheostomy patients group. Key words: Tracheostomy, Ventilator weaning, Mortality rate Correspondence: Chun-Yi Lee Department of Chest medicine, Respiratory therapy, Tri-Service General Hospital, Taiwan; No. 325, Sec. 2, Cheng-Keng Rd., Nei-Hsu, Taipei, Taiwan Phone: ext.16885; Fax: ; 109

Mobilizing the Patient in the Intensive Care Unit: The Role of Early Tracheotomy

Crit Care Clin 23 (2007) 71 79 Mobilizing the Patient in the Intensive Care Unit: The Role of Early Tracheotomy Stephen R. Clum, MD, PhD, Mark J. Rumbak, MD, FCCP* Department of Internal Medicine, Division