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[NEJM发表论文]:高流量氧疗且封闭气管切开管或吸痰对拔除气管切开管的影响
2020年09月16日 时讯速递, 进展交流 暂无评论

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High-Flow Oxygen with Capping or Suctioning for Tracheostomy Decannulation

Gonzalo Hernández Martínez, Maria-Luisa Rodriguez, Maria-Concepción Vaquero, et al

N Engl J Med 2020; 383:1009-1017
DOI: 10.1056/NEJMoa2010834

Abstract 摘要

BACKGROUND 背景

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.

如果气管切开患者恢复到可能拔出气管切开管的状态,通常做法是封闭气管切开管24小时,观察患者能否自主呼吸。与根据吸痰频率的判断相比,判断患者能否拔除气管切开管的这一做法能否导致更好的预后尚不清楚。

METHODS 方法

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.

在5个ICU中,我们入选了意识清楚且有气管切开管的成年危重病患者,入选标准包括脱离机械通气。在这项非盲研究中,患者接受随机分组,分别接受24小时封闭气管切开管及间断高流量氧疗(对照组)或持续高流量氧疗且根据吸痰频率确定能否把管(干预组)。主要预后指标为拔管时间(采用log-rank检验进行比较)。次要预后指标包括拔管失败,脱机失败,呼吸道感染,脓毒症,多器官功能衰竭,ICU住院日及总住院日,以及ICU病死率和住院病死率。

RESULTS 结果

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.

试验纳入330名患者,平均(±SD) 年龄 58.3±15.1 岁,68.2%为男性。对照组共161名患者,干预组169名患者。干预组拔除气管切开管的时间短于对照组 (中位数, 6 天 [四分位区间, 5 to 7] vs. 13 天 [四分位区间, 11 to 14]; 绝对差异, 7 天 [95% 可心区间, 5 to 9])。干预组患者肺炎和气管支气管炎发生率低于对照组,住院日更短。两组患者其他次要预后指标结果相似。

CONCLUSIONS 结论

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. (REDECAP ClinicalTrials.gov number, NCT02512744. opens in new tab.)

与封闭气管切开管24小时联合间断高流量氧疗相比,根据吸痰频率决定拔除气管切开管能够缩短拔管时间,且没有证据表明拔管失败率在两组之间存在显著差异。

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