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Titolo:
A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients
Autore:
Freeman, BD; Isabella, K; Cobb, JP; Boyle, WA; Schmieg, RE; Kolleff, MH; Lin, N; Saak, T; Thompson, EC; Buchman, TG;
Indirizzi:
Washington Univ, Sch Med, Dept Surg, St Louis, MO 63110 USA Washington Univ St Louis MO USA 63110 , Dept Surg, St Louis, MO 63110 USA Washington Univ, Sch Med, Dept Anesthesiol, St Louis, MO 63110 USA Washington Univ St Louis MO USA 63110 Anesthesiol, St Louis, MO 63110 USA Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA Washington Univ St Louis MO USA 63110 d, Dept Med, St Louis, MO 63110 USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 5, volume: 29, anno: 2001,
pagine: 926 - 930
SICI:
0090-3493(200105)29:5<926:APRSCP>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
DILATATIONAL TRACHEOSTOMY; INTENSIVE-CARE; TRIAL; SAFE; ICU;
Keywords:
percutaneous dilational tracheostomy; surgical tracheostomy; mechanical ventilation; cost-effective; respiratory failure; surgical intensive care; anesthesiology; critical care; delivery of health care; health services research; medicine; otolaryngology; surgery; technology; therapeutics; traumatology;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
25
Recensione:
Indirizzi per estratti:
Indirizzo: Freeman, BD Washington Univ, Sch Med, Dept Surg, St Louis, MO 63110 USA Washington Univ St Louis MO USA 63110 St Louis, MO 63110 USA
Citazione:
B.D. Freeman et al., "A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients", CRIT CARE M, 29(5), 2001, pp. 926-930

Abstract

Objective: To determine the relative cost-effectiveness of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) in critically ill patients. Design: Prospective randomized study. Setting: Medical, surgical, and coronary intensive care units at Barnes-Jewish Hospital, a tertiary care medical center. Patients: Eighty critically ill mechanically ventilated patients requiringelective tracheostomy. Interventions: Randomization to either PDT performed in the intensive careunit or ST performed in the operating room. Measurements and Main Results: Treatment groups were well matched with respect to age (PDT, 65.44 +/- 2.82 [mean +/- se] years; ST, 61.4 +/- 2.89 years, p = Ns), gender (PDT, 45% males; ST, 47.5% males, p = NS), severity of illness (Acute Physiology and Chronic Health Evaluation II score: PDT, 16.87 +/- 0.84; ST, 17.88 +/- 0.92, p = NS), and principle diagnosis. PDT was performed more quickly (PDT, 20.1 +/- 2.0 mins; ST, 41.7 +/- 3.9 mins, p < .0001) and was associated with lower patient charges than ST (total patient charges: PDT, $1,569 <plus/minus> $157 vs. ST, $3,172 +/- $114; equipment/supply charges: PDT, $688 +/- $103 vs. ST, $1,526 +/- $87; professional charges: PDT, $880 +/- $54 vs. ST, $1,647 +/- $50; p < .0001 for all). There were no differences in days intubated before tracheostomy (PDT, 12.7 <plus/minus> 1.1 days; ST, 15.6 +/- 1.9, p = .20), intensive care unit length of stay (PDT, 24.5 +/- 2.5 days; ST, 28.5 +/- 3.1 days, p.33), or hospital length of stay (PDT 49.7 +/- 4.2 days; ST, 43.7 +/- 3.5 days, p = .28) when we compared these two techniques. Conclusions: PDT is a cast-effective alternative to ST. The reduction in patient charges associated with PDT in this study resulted from the procedure being performed in the intensive care unit, thus eliminating the need foroperating room facilities and personnel. PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 16:31:28