Outcomes Associated With Airway Management of Adult Trauma Patients Admitted to Surgical Intensive Care.

Autor:	Cunningham E; Surgical Intensive Care, Good Samaritan University Hospital, West Islip, USA., O'Rourke D; Performance Improvement, Good Samaritan University Hospital, West Islip, USA., Fitzgerald K; Quality Improvement, Good Samaritan University Hospital, West Islip, USA., Azab N; Intensive Care, Good Samaritan University Hospital, West Islip, USA., Rothburd L; Trauma, Good Samaritan University Hospital, West Islip, USA., Awgul B; Medical Library, Good Samaritan University Hospital, West Islip, USA., Raio C; Emergency Medicine, Good Samaritan University Hospital, West Islip, USA., Klein LR; Emergency Medicine, Good Samaritan University Hospital, West Islip, USA., Caronia C; Pediatrics, Good Samaritan University Hospital, West Islip, USA., Reens H; Nursing, Molloy University, Rockville Centre, USA., Drucker T; Nursing, Molloy University, Rockville Centre, USA., Qandeel F; Research, Good Samaritan University Hospital, West Islip, USA., Mahia A; Medicine, City University of New York, New York City, USA., Kaur A; Medicine, City University of New York, New York City, USA., Eckardt S; Data Science, Eckardt & Eckardt Consulting, St. James, USA., Eckardt PA; Nursing, Good Samaritan University Hospital, West Islip, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Dec 17; Vol. 16 (12), pp. e75875. Date of Electronic Publication: 2024 Dec 17 (Print Publication: 2024).
DOI:	10.7759/cureus.75875
Abstrakt:	Introduction: Advanced airway management and ventilation of trauma patients are often needed during acute stabilization and resuscitation and later, in those admitted. In addition to endotracheal intubation for advanced airway management, tracheostomy is commonly used in critically ill patients when prolonged mechanical ventilation is required. However, the outcomes associated with airway management approaches and the timing of a tracheostomy in critically ill patients are mixed. This protocol intended to compare the effect of tracheostomy in major trauma patients vs. management with non-invasive techniques and endotracheal intubation during admission, examine complications and outcomes associated with the three types of airway management approaches, and explore the association of clinical and social determinants of health variables with complications in patients requiring advanced airway management. Methods: A total of 911 adult trauma patients admitted to a Level 1 trauma center surgical intensive care unit (SICU) were included in this retrospective, single-center, quantitative study from 2019 to 2021. Descriptive and correlational analyses were used to examine outcomes of ventilator days, length of stay, pneumonia, readmission, mortality, and associations with the airway management approach. The outcomes of ventilator days and length of stay were compared between groups with a one-way ANOVA, and differences between groups on outcomes of pneumonia, readmission, and mortality were estimated using crosstabulations and chi-square (x²) statistics. Hypothesized relationships of clinical and social determinants of health variables associated with outcomes of ventilator days, hospital length of stay, pneumonia, readmission, and mortality in patients requiring advanced airway management ≥ four days were estimated. Results: There was no significant difference in outcomes of pneumonia and mortality between the advanced airway management groups (p=0.856 and p=0.167, respectively). There were significant differences in ventilator days, length of stay (LOS), and readmission. Between the groups: endotracheal intubation only, early (<10 days post-intubation) tracheostomy, and late (>10 days post-intubation) tracheostomy in SICU patients (p <0.001, p=0.028, and p=0.003, respectively). Specifically, patients in the early tracheostomy group had a higher readmission rate (33.3%) as compared to endotracheal tube patients (2.3%) and late tracheostomy patients (0.0%). Social determinants of health variables (smoking and functional dependence) were also significantly correlated with readmission in the early tracheostomy and endotracheal tube airway management groups (p=.047 and p=.022, respectively). Additionally, clinical variables of injury severity scores, ED arrival systolic blood pressure (SBP), and presence of pre-existing comorbidities were found to be significantly associated with complications of pneumonia, readmission, and mortality within the patients (n=229) requiring advanced airway approaches. Conclusion: Adult trauma patients with early tracheostomy airway management may experience a higher readmission rate related to the complexity of their injuries than patients managed with endotracheal intubation or late tracheostomy. Clinical and social determinants of health factors may be associated with complications. Further studies examining these associations in larger samples are needed to examine the validity of these findings. Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Institutional Review Board (IRB) of the Good Samaritan University Hospital issued approval (IRB # 22-010). As this research included experimentation on human subjects' data, this study was approved by the institution’s ethics committee, the Good Samaritan University Hospital Institutional Review Board (IRB # 22-010), receiving an exempt category designation 45 CFR 46.104 Category 4(iii) (2018 Requirements) prior to conducting the research. This research was conducted according to established ethical guidelines, and informed consent was obtained from the participants according to the federal requirements described in 45 CFR 46.104. This research study complies with all regulations and informed consent was obtained as required by 45 CFR 46.104. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Cunningham et al.)
Databáze:	MEDLINE
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