根据吸氧频率来决定气管插管拔管时机可改善临床预后 作者： 发布时间：/9/12 22:29:12 西班牙圣女德拉萨鲁德大学医院Gonzalo Hern ndez Mart nez团队比较了高流量氧疗封闭管道或吸氧频率来评估气管切开插管患者拔管的效果。9月10日，该研究发表在《新英格兰医学杂志》上。
当接受气管切开插管的患者在治疗中达到可拔管阶段时，通常做法是将气管切开插管封闭24小时，以查看患者是否能自主呼吸。与基于气道呼吸频率的方法相比，尚不清楚这种拔管准备方法是否会改善临床预后。
在这项非盲试验中，研究组在五个重症监护病房（ICU）招募了330例有气管切开插管、意识清醒、符合停止机械通气标准的重症成年人，将其随机分为两组，其中161例接受24小时封闭试验和间歇性高流量氧疗（对照组），169例接受连续高流量氧疗，以吸氧频率作为拔管准备就绪的指标（干预组）。主要结局为拔管时间。
330名患者的平均年龄为58.3岁，其中男性占68.2%。干预组的平均拔管时间为6天，显著短于对照组（13天）。与对照组相比，干预组中肺炎和气管支气管炎的发生率显著降低，且住院时间显著缩短。两组间其他次要结局均无显著差异。
总之，根据吸氧频率联合连续高流量氧疗的指标来决定拔管，与24小时封闭试验联合间歇性高流量氧疗相比，可有效缩短拔管时间。
附：英文原文
Title: High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation
Author: Gonzalo Hern ndez Mart nez, M.D., Ph.D.,, Maria-Luisa Rodriguez, M.D.,, Maria-Concepci n Vaquero, M.D.,, Ram n Ortiz, M.D., Ph.D.,, Joan-Ramon Masclans, M.D., Ph.D.,, Oriol Roca, M.D., Ph.D.,, Laura Colinas, M.D., Ph.D.,, Raul de Pablo, M.D., Ph.D.,, Maria-del-Carmen Espinosa, M.D., Ph.D.,, Marina Garcia-de-Acilu, M.D.,, Cristina Climent, M.D.,, and Rafael Cuena-Boy, M.D.
Issue Volume: -09-10
Abstract:
Background
When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear.
Methods
In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital.
Results
The trial included 330 patients; the mean ( SD) age of the patients was 58.3 15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups.
Conclusions
Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure.
DOI: 10.1056/NEJMoa834
Source:
期刊信息
The New England Journal of Medicine：《新英格兰医学杂志》，创刊于18。隶属于美国麻省医学协会，最新IF：70.67
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