prolonged mechanical ventilation in a respiratory-care setting a comparison of outcome between tracheostomized and translaryngeal intubated patients长期机械通气在呼吸呵护环境之间的比较结果tracheostomized和translaryngeal插管的病人.pdfVIP

Wu et al. Critical Care 2010, 14:R26 /content/14/2/R26 RESEARCH Open Access Prolonged mechanical ventilation in a respiratory- care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients 1,2† 3,4*† 1 1 1 3 Yao-Kuang Wu , Ying-Huang Tsai , Chou-Chin Lan , Chun-Yao Huang , Chih-Hsin Lee , Kuo-Chin Kao , Jui-Ying Fu3 Abstract Introduction: Mechanical ventilation of patients may be accomplished by either translaryngeal intubation or tracheostomy. Although numerous intensive care unit (ICU) studies have compared various outcomes between the two techniques, no definitive consensus indicates that tracheostomy is superior. Comparable studies have not been performed in a respiratory care center (RCC) setting. Methods: This was a retrospective observational study of 985 tracheostomy and 227 translaryngeal intubated patients who received treatment in a 24-bed RCC between November 1999 and December 2005. Treatment and mortality outcomes were compared between tracheostomized and translaryngeal intubated patients, and the factors associated with positive outcomes in all patients were determined. Results: Duration of RCC (22 vs. 14 days) and total hospital stay (82 vs. 64 days) and total mechanical ventilation days (53 vs. 41 days) were significantly longer in tracheostomized patients (all P 0.05). The rate of in-hospital mortality was significantly higher in the translaryngeal group (45% vs. 31%;P 0.05). No significant differences were found in weaning success between the groups (both were 55%) or in RCC mortality. Because of significant baseline between-group heterogeneity, case-match analysis was performed. This analysis confirmed the whole cohort fi