Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis
| Autor: | Arnaud de Lassence, Samir Jamali, Yves Cohen, Elie Azoulay, Maité Garrouste-Orgeas, Dany Toledano, Christophe Adrie, Isabelle Zaccaria, Christophe Clec’h, François Vincent, Corinne Alberti, Jean-François Timsit |
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| Přispěvatelé: | Service de Réanimation Médico-Chirurgicale [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de bactériologie, virologie, parasitologie et hygiène, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Unité d'épidémiologie clinique, Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'enzymologie et biochimie structurales (LEBS), Centre National de la Recherche Scientifique (CNRS), Medical-Surgical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Hôpital Saint Joseph, Service de soins intensifs, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Hôpital de Gonesse, Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Clinique de réanimation médicale, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Service de réanimation chirurgicale [Béclère], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Institut de Biologie du Développement de Marseille (IBDM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Groupe de Recherche Sur Le Cancer du Poumon : Bases Moléculaires de la Progression Tumorale, Dépistage et Thérapie Génique, Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de bactériologie, virologie, parasitologie et hygiène [CHU Necker], Institut national des sciences de l'Univers (INSU - CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Institut de Physique du Globe de Paris (IPG Paris)-Centre National de la Recherche Scientifique (CNRS), Vesin, Aurélien, Université Paris 13 ( UP13 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Avicenne, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'enzymologie et biochimie structurales ( LEBS ), Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Descartes - Paris 5 ( UPD5 ) -Hôpital Saint Joseph, Assistance publique - Hôpitaux de Paris (AP-HP)-Hopital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble-Hôpital Albert Michallon, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Antoine Béclère, Institut de Biologie du Développement de Marseille ( IBDM ), Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Physique du Globe de Paris ( IPGP ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -IPG PARIS-Université Paris Diderot - Paris 7 ( UPD7 ) -Université de la Réunion ( UR ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Albert Bonniot-Institut National de la Santé et de la Recherche Médicale ( INSERM ) |
| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
Male
Time Factors medicine.medical_treatment MESH : Prospective Studies MESH : Aged MESH: Logistic Models MESH : Critical Illness Critical Care and Intensive Care Medicine Logistic regression MESH : Intensive Care law.invention MESH: Cause of Death MESH : Tracheostomy MESH: Selection Bias Tracheostomy 0302 clinical medicine MESH: Tracheostomy Risk Factors law MESH: Risk Factors Cause of Death MESH : Female Hospital Mortality Prospective Studies MESH: APACHE MESH: Respiration Artificial APACHE MESH: Treatment Outcome MESH: Aged MESH: Middle Aged Confounding Factors Epidemiologic [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie MESH : Selection Bias Middle Aged MESH : Adult MESH : Risk Factors Intensive care unit Treatment Outcome MESH: Survival Analysis MESH: Critical Illness Female France MESH : APACHE MESH : Time Factors Cohort study Adult medicine.medical_specialty Critical Care Critical Illness MESH : Male MESH : Treatment Outcome MESH: Multivariate Analysis MESH : Hospital Mortality 03 medical and health sciences Intensive care medicine Humans MESH : Middle Aged MESH: Patient Selection MESH: Intensive Care MESH: Hospital Mortality MESH : Respiration Artificial MESH : Confounding Factors (Epidemiology) MESH : France Selection Bias Aged MESH : Cause of Death Mechanical ventilation MESH: Humans business.industry Patient Selection MESH : Humans MESH: Time Factors MESH: Confounding Factors (Epidemiology) MESH : Multivariate Analysis 030208 emergency & critical care medicine MESH: Adult Odds ratio MESH : Patient Selection Respiration Artificial Survival Analysis Confidence interval MESH: Male MESH: Prospective Studies Surgery MESH: France Logistic Models 030228 respiratory system [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie Multivariate Analysis Propensity score matching Emergency medicine [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie MESH : Survival Analysis business MESH: Female MESH : Logistic Models |
| Zdroj: | Critical Care Medicine Critical Care Medicine, Lippincott, Williams & Wilkins, 2007, 35 (1), pp.132-8. ⟨10.1097/01.CCM.0000251134.96055.A6⟩ Critical Care Medicine, 2007, 35 (1), pp.132-8. ⟨10.1097/01.CCM.0000251134.96055.A6⟩ Critical Care Medicine, Lippincott, Williams & Wilkins, 2007, 35 (1), pp.132-8. 〈10.1097/01.CCM.0000251134.96055.A6〉 |
| ISSN: | 0090-3493 1530-0293 |
| DOI: | 10.1097/01.CCM.0000251134.96055.A6⟩ |
| Popis: | International audience; OBJECTIVE: To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN: Prospective, observational, cohort study. SETTING: Twelve French medical or surgical intensive care units. PATIENTS: Unselected patients requiring mechanical ventilation for > or =48 hrs enrolled between 1997 and 2004. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two models of propensity scores for tracheostomy were built using multivariate logistic regression. After matching on these propensity scores, the association of tracheostomy with outcomes was assessed using multivariate conditional logistic regression. Results obtained with the two models were compared. Of the 2,186 patients included, 177 (8.1%) received a tracheostomy. Both models led to similar results. Tracheostomy did not improve intensive care unit survival (model 1: odds ratio, 0.94; 95% confidence interval, 0.63-1.39; p = .74; model 2: odds ratio, 1.12; 95% confidence interval, 0.75-1.67; p = .59). There was no difference whether tracheostomy was performed early (within 7 days of ventilation) or late (after 7 days of ventilation). In patients discharged free from mechanical ventilation, tracheostomy was associated with increased postintensive care unit mortality when the tracheostomy tube was left in place (model 1: odds ratio, 3.73; 95% confidence interval, 1.41-9.83; p = .008; model 2: odds ratio, 4.63; 95% confidence interval, 1.68-12.72, p = .003). CONCLUSIONS: Tracheostomy does not seem to reduce intensive care unit mortality when performed in unselected patients but may represent a burden after intensive care unit discharge. |
| Databáze: | OpenAIRE |
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