一项大型多中心队列横断面研究中与 COVID-19 状态有关的插管后喉气管狭窄风险

Q4 Medicine
Raluca Gray, P. M. Pradhan, Jesse Hoffmeister, S. Misono, Roy Cho, Christopher Tignanelli
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引用次数: 0

摘要

目的:与 COVID-19 状态相关的插管后喉气管狭窄 (LTS) 发生率。设计:回顾性横断面住院患者数据库。地点:美国中西部 11 家学术和社区医院。患者:2020 年 1 月至 2022 年 8 月期间接受机械通气治疗的成人,随后在 6 个月内再次入院并被诊断为 LTS。干预:无。测量和主要结果:6815名COVID-19阴性患者和1316名COVID-19阳性患者接受了插管治疗,他们的年龄(中位数63.77岁 vs. 63.16岁)、性别(男性,60.8%;n = 4173 vs. 60%;n = 789)、气管导管大小(≥7.5,75.8%;n = 5192 vs. 75.5%;n = 994)和合并症分布相似。COVID-19阳性组的ICU住院时间(中位数[四分位距(IQR)],7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d])和机械通气天数(中位数[四分位距(IQR)],5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d])更长。COVID-19 阳性组的 LTS 发生率增加了一倍(12.7%,n = 168 vs. 6.4%,n = 440;p < 0.001),最常在插管后 60 天内确诊。在多变量分析中,ICU 每增加一天,LTS 风险增加 2%(危险比 [HR],1.02;95% CI,1.02-1.03;p < 0.001);每增加一天通气,LTS 风险增加 3%(HR,1.03;95% CI,1.02-1.04;p < 0.001);每增加一次重新插管,LTS 风险增加 52%(HR,1.52;95% CI,1.36-1.71;p < 0.001)。我们观察到 COVID-19 状态与 LTS 风险无明显关联。结论:在 COVID-19 阳性组群中,插管后 LTS 的发生率是原来的两倍,随着插管天数、重症监护室天数的增加,尤其是随着再次插管次数的增加,发生 LTS 的风险更高。COVID-19 状态并非 LTS 的独立风险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study
OBJECTIVES: Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status. DESIGN: Retrospective cross-sectional inpatient database. SETTING: Eleven Midwest academic and community hospitals, United States. PATIENTS: Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13–16.67 d] vs. 3.95 d [1.91–8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01–14.18 d] vs. 1.37 d [0.35–4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02–1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02–1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36–1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS. CONCLUSIONS: The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
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CiteScore
5.70
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