• 作者：M. Prieto-Gonz¨¢lez ; J.B. L¨®pez-Messa ; S. Moradillo-Gonz¨¢lez ; Z.M. Franz¨®n-Laz ; M. Ortega-S¨¢ez ; M. Poncela-Blanco ; I. Alonso-Casta?eira ; J. Andr¨¦s-de Llano.
• 关键词：Traqueotomí ; a ; Soporte ventilatorio ; Cuidados crí ; ticos ; Decanulació ; n
• 刊名：Medicina Intensiva
• 出版年：2013
• 出版时间：August-September, 2013
• 年：2013
• 卷：37
• 期：6
• 页码：400-408
• 全文大小：433 K

ss=""h4"">Objective

To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway.

ss=""h4"">Design

A prospective, observational cohort study was carried out.

ss=""h4"">Intervention

Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process.

ss=""h4"">Setting

A polyvalent ICU.

ss=""h4"">Patients

We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ¡Ý 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ).

ss=""h4"">Variables of interest

ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period.

ss=""h4"">Results

ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47 % TP vs. 89 % TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31 % vs. 11 % , p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04).

ss=""h4"">Conclusions

The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.