COVID-19大流行前后气管切开使用、气管切开依赖及结局的趋势

文献信息

中文摘要

目的： COVID-19大流行导致对有创机械通气的需求空前增加，并可能影响气管切开的使用、依赖及气道相关结局。然而，大流行前后的人群水平趋势仍缺乏充分描述。我们评估了COVID-19大流行前后接受插管和机械通气患者中气管切开使用、依赖及气道相关并发症的时间趋势。
方法： 我们使用TriNetX美国协作网络的去标识化数据开展了一项回顾性队列研究。纳入2016年至2023年接受气管插管和呼吸通气的成人（≥18岁）。患者被分为大流行前（2016-2019年）和大流行期间（2020-2023年）队列。对13项人口学和临床协变量进行了倾向评分匹配。主要结局为气管切开和气管切开依赖，次要结局包括气道相关并发症。计算了风险比（RR）及95%置信区间（CI）。
结果： 在155,499例接受插管和机械通气的患者中，气管切开、气管切开依赖和吞咽困难的发生比例从2016年至2023年分别增加约2.1倍、3.3倍和2.3倍。匹配后（每队列n=64,732），大流行前与大流行期间队列的气管切开手术率无差异（RR：0.97，95% CI：0.91-1.02）。然而，大流行期间患者发生气管切开依赖（RR：1.14，95% CI：1.08-1.21）和吞咽困难（RR：1.07，95% CI：1.04-1.10）的风险更高。
结论： 大流行期间气管切开依赖和部分气道并发症增加，提示大流行后重症监护实践可能产生持久的下游影响。需要对气管切开患者进行前瞻性资源规划和长期气道护理策略。
证据等级： 3。

英文摘要

OBJECTIVES: The COVID-19 pandemic led to an unprecedented demand for invasive mechanical ventilation and may have affected tracheostomy utilization, dependence, and airway-related outcomes. However, population-level trends before and after the pandemic remain poorly characterized. We evaluated temporal trends in tracheostomy utilization, dependence, and airway-related complications among intubated and mechanically ventilated patients before versus after the COVID-19 pandemic.
METHODS: We conducted a retrospective cohort study using de-identified data from the TriNetX U.S. Collaborative Network. Adults (≥ 18 years) who underwent endotracheal intubation and respiratory ventilation from 2016 to 2023 were included. Patients were stratified into pre-pandemic (2016-2019) and pandemic (2020-2023) cohorts. Propensity score matching was performed on 13 demographic and clinical covariates. Primary outcomes were tracheostomy and tracheostomy dependence, and secondary outcomes included airway-related complications. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.
RESULTS: Among 155,499 intubated and mechanically ventilated patients, the incidence proportions of tracheostomy, tracheostomy dependence, and dysphagia increased from 2016 to 2023 by approximately 2.1, 3.3, and 2.3 times, respectively. After matching (n = 64,732 per cohort), there was no difference in tracheostomy surgical rates between pre- and pandemic cohorts (RR: 0.97, 95% CI: 0.91-1.02). However, pandemic patients had higher risks of tracheostomy dependence (RR: 1.14, 95% CI: 1.08-1.21) and dysphagia (RR: 1.07, 95% CI: 1.04-1.10).
CONCLUSION: Tracheostomy dependence and select airway complications increased in the pandemic period, suggesting lasting downstream effects of critical care practices after the pandemic. Proactive resource planning and long-term strategies for airway care in tracheotomized patients are needed.
LEVEL OF EVIDENCE: 3.