Percutaneous Dilatational Tracheostomy in a Cardiac Surgical Intensive Care Unit: A Single-Center Experience.

Q4 Medicine
Vignesh Vudatha, Yahya Alwatari, George Ibrahim, Tayler Jacobs, Kyle Alexander, Carlos Puig-Gilbert, Walker Julliard, Rachit Dilip Shah
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引用次数: 0

Abstract

Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients.

Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate.

Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04).

Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.

Abstract Image

心脏外科重症监护病房的经皮扩张性气管切开术:单中心经验。
背景:相当比例的心脏外科重症监护病房(CSICU)患者需要长期通气,需要气管造口术。本研究的目的是评估CSICU患者经皮扩张性气管切开术(PDT)的长期术后结果和并发症。方法:选取2013年1月1日至2021年1月1日在CSICU进行心脏、胸部或血管手术后接受PDT的所有患者。评估他们的死亡率、拔管时间、并发症包括出血、感染和手术干预的需要。采用多变量回归模型确定早期脱管和并发症发生率的预测因素。结果:本研究共纳入93例患者,其中男性70例(75.3%),女性23例(24.7%)。此外,18.3%的患者患有慢性阻塞性肺疾病(COPD), 21.5%有卒中史,7.5%患有终末期肾病,33.3%患有糖尿病,59.1%目前是吸烟者。从PDT到去管术的平均时间为39天。约五分之一(20.4%)的患者接受双重抗血小板治疗,81.7%的患者在气管切开8小时后重新开始抗凝治疗。8例并发症,包括5例出血需要填塞和1例纵隔炎。在出院前没有明显的预测因素。在任何时间点,只有COPD被确定为脱管的负面预测因子(风险比,0.28;95%置信区间为0.08-0.95;p = 0.04)。结论:经皮气管切开术是心脏外科ICU患者气管切开术安全可行的替代方法。接受PDT的患者气管切开术的持续时间相对较短,并且没有主要的术后并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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