根據吸氧頻率來決定氣管插管拔管時機可改善臨床預後
作者：
小柯機器人發布時間：2020/9/12 22:29:12
西班牙聖女德拉薩魯德大學醫院Gonzalo Hernández Martínez團隊比較了高流量氧療封閉管道或吸氧頻率來評估氣管切開插管患者拔管的效果。2020年9月10日，該研究發表在《新英格蘭醫學雜誌》上。
當接受氣管切開插管的患者在治療中達到可拔管階段時，通常做法是將氣管切開插管封閉24小時，以查看患者是否能自主呼吸。與基於氣道呼吸頻率的方法相比，尚不清楚這種拔管準備方法是否會改善臨床預後。
在這項非盲試驗中，研究組在五個重症監護病房（ICU）招募了330例有氣管切開插管、意識清醒、符合停止機械通氣標準的重症成年人，將其隨機分為兩組，其中161例接受24小時封閉試驗和間歇性高流量氧療（對照組），169例接受連續高流量氧療，以吸氧頻率作為拔管準備就緒的指標（幹預組）。主要結局為拔管時間。
330名患者的平均年齡為58.3歲，其中男性佔68.2%。幹預組的平均拔管時間為6天，顯著短於對照組（13天）。與對照組相比，幹預組中肺炎和氣管支氣管炎的發生率顯著降低，且住院時間顯著縮短。兩組間其他次要結局均無顯著差異。
總之，根據吸氧頻率聯合連續高流量氧療的指標來決定拔管，與24小時封閉試驗聯合間歇性高流量氧療相比，可有效縮短拔管時間。
附：英文原文
Title: High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation
Author: Gonzalo Hernández Martínez, M.D., Ph.D.,, Maria-Luisa Rodriguez, M.D.,, Maria-Concepción Vaquero, M.D.,, Ramón Ortiz, M.D., Ph.D.,, Joan-Ramon Masclans, M.D., Ph.D.,, Oriol Roca, M.D., Ph.D.,, Laura Colinas, M.D., Ph.D.,, Raul de Pablo, M.D., Ph.D.,, Maria-del-Carmen Espinosa, M.D., Ph.D.,, Marina Garcia-de-Acilu, M.D.,, Cristina Climent, M.D.,, and Rafael Cuena-Boy, M.D.
Issue&Volume: 2020-09-10
Abstract:
Background
When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear.
Methods
In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital.
Results
The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups.
Conclusions
Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure.
DOI: 10.1056/NEJMoa2010834
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2010834