Arnaud W Thille, Constance Bayon, Marie Gauvrit, Clément Saccheri, Marie Labruyere, Gaetan Beduneau, Guilhem Wattecamps, Matthieu Henry, Eddine Bendiab, Benjamin Swinyard, Arnaud Gacouin, Adam Celier, Benjamin Foucou, Suzanne Champion, Anne-Fleur Haudebourg, Laurence Dangers, Olivier Plateker, Cedric Daubin, Lucie Fromont, Charlotte Guesdon, Emmanuel Vivier, Lev Volkov, Cyril Potier, Jeremy Bourenne, Charlotte Chiquet, Valentin Pointurier, Louis Chauvelot, Pierre Bailly, David Schnell, Nicholas Sedillot, Florian Reizine, Laurent Argaud, Faustine Reynaud, Juliette Pelle, Olivier Lesieur, Adrien Auvet, Guillaume Lacave, Marion Kernevez, Damien Contou, Guillaume Grillet, Arnaud Delahaye, Julio Badie, Jerome Devaquet, Hermine Chauvin, Alexandra Beurton, Emanuele Turbil, Jean-Philippe Rigaud, Stéphanie Ragot, Louis Chamblet, Sylvain Le Pape, Rémi Coudroy
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引用次数: 0
Abstract
Background: Whether or not a direct tracheostomy without any prior weaning attempt is beneficial in patients intubated for Guillain-Barré syndrome (GBS) remains to be determined. Our objective was to determine whether direct tracheostomy results in earlier or later ventilator weaning compared to standard weaning.
Methods: Multicenter, retrospective cohort study including all patients intubated for GBS over a 10-year period (2014-2023). We compared patients having undergone direct tracheostomy without any prior weaning attempt with those having undergone standard weaning (spontaneous-breathing trial or extubation attempt). We also compared direct tracheostomy with tracheostomy after weaning failure. The primary outcome was the proportion of patients alive and free from mechanical ventilation 28 days after weaning initiation.
Results: Overall, 221 patients (45%) underwent direct tracheostomy and 273 (55%) standard weaning. Compared to patients with standard weaning, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation at day 28 (43% vs. 83%, p < 0.001). Using G-computation to estimate the marginal causal effect of the weaning strategy, standard weaning was more effective than direct tracheostomy in reducing the risk of remaining under mechanical ventilation at day 28: -39.5% [95% Confidence Interval, -47.3% to -31.5%]. Even when compared to patients having undergone tracheostomy after weaning failure, those with direct tracheostomy were less likely to be alive and free from mechanical ventilation 28 days after the tracheostomy procedure.
Interpretation: A direct tracheostomy without any prior weaning attempt might significantly delay the ventilator weaning process in patients intubated for GBS.
背景：对于插管治疗格林-巴勒综合征（GBS）的患者，在没有任何事先脱机尝试的情况下进行气管切开术是否有益仍有待确定。我们的目的是确定与标准脱机相比，直接气管切开术是否会导致更早或更晚的呼吸机脱机。方法：多中心、回顾性队列研究，包括所有10年（2014-2023年）插管治疗GBS的患者。我们比较了直接气管切开术且没有任何事先脱机尝试的患者与进行标准脱机（自主呼吸试验或拔管尝试）的患者。我们还比较了直接气管造口术和脱机失败后气管造口术。主要结局是在断奶后28天存活且无机械通气的患者比例。结果：总体而言，221例（45%）患者接受了直接气管切开术，273例（55%）接受了标准脱机。与标准脱机的患者相比，直接气管切开术患者在第28天存活和不使用机械通气的可能性更低（43% vs. 83%, p）。解释：在没有任何脱机尝试的情况下进行直接气管切开术可能会显著延迟GBS插管患者的呼吸机脱机过程。临床试验注册：NCT07022028。
期刊介绍：
Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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