Traqueostomia Percutânea Guiada Por Ultrassom Conduzida Por Intensivistas: Um Estudo De Coorte De Fase IV

Pedro Fortes Osório Bustamante,Bruno Adler Maccagnan Pinheiro Besen, Amanda Pinto Botêga, Filipe Matheus Cadamuro,Marcelo Park,Pedro Vitale Mendes,Roberta Muriel Longo Roepke

Critical Care Science（2023）

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Abstract

OBJECTIVE: To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials. METHODS: This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021. RESULTS: There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%. CONCLUSION: Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.

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【要点】：该研究描述了在常规实施后，重症医生主导的超声引导下经皮扩张气管切开术在真实世界场景下的大量患者情况，以及该程序可能的风险和并发症。

【方法】：这是一项四期队列研究，研究对象为2017年9月至2021年12月间入住巴西一家四级学术医院三个重症监护室并接受重症医生主导的超声引导下经皮扩张气管切开术的患者。

【实验】：研究期间共有4810次重症监护室入院，2084名患者接受了机械通气，其中287名患者接受了气管切开术，227名患者在床边由重症监护团队完成手术。手术的主要并发症发生率为29.5%，最常见的并发症是血流动力学不稳定和手术中的脱管，严重并发症仅有3例。重症监护室死亡率为29.1%，医院死亡率为43.6%。