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Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study

Tuberculosis and Respiratory Diseases 2020년 83권 2호 p.167 ~ 174
강예원, Yoo Wan-Ho, 김영웅, 안효영, 이상희, 이광하,
소속 상세정보
강예원 ( Kang Ye-Won ) - Pusan National University School of Medicine Department of Internal Medicine
 ( Yoo Wan-Ho ) - Pusan National University School of Medicine Department of Internal Medicine
김영웅 ( Kim Young-Woong ) - Pusan National University School of Medicine Department of Trauma Surgery
안효영 ( Ahn Hyo-Yeong ) - Pusan National University School of Medicine Department of Thoracic and Cardiovascular Surgery
이상희 ( Lee Sang-Hee ) - Wonkwang University Sanbon Hospital Department of Internal Medicine
이광하 ( Lee Kwang-Ha ) - Pusan National University School of Medicine Department of Internal Medicine

Abstract


Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours).

Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008?February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2?10 days and >10 days after translaryngeal intubation, respectively.

Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001).

Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

키워드

Tracheostomy; Mechanical Ventilation; Mortality

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