ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ CÁC YẾU TỐ NGUY CƠ TỬ VONG NỘI VIỆN CỦA BỆNH NHÂN MỞ KHÍ QUẢN SAU THỞ MÁY

Abstract

Background: Tracheostomy is commonly carried out in patients who require prolonged mechanical ventilation, such as those with stroke, traumatic brain injury, pneumonia, and other respiratory conditions. Its purpose is to aid in respiratory care. Nonetheless, tracheostomy is associated with an elevated risk of respiratory tract infections, as well as post-tracheostomy complications, both of which can contribute to higher in-hospital mortality rates. Objectives: To describe the clinical and subclinical characteristics of patients with tracheostomy after mechanical ventilation and identify risk factors for in-hospital mortality. Methods: A prospective cohort study was conducted on 119 patients with tracheostomy after mechanical ventilation at the HCMC Hospital for Rehabilitation - Professional Diseases from October 2022 to April 2023. Results: The median patient age was 51 years old, with men being three times more likely than women. The median number of co-morbidities was three diseases, with the most common being diabetes, hypertension, chronic lung disease, and dyslipidemia. Common symptoms included cough, impaired consciousness, and difficulty breathing. Chest X-ray images mostly showed consolidation and interstitial ± alveolar opacity, with 82.4% of patients having pneumonia. The median duration of mechanical ventilation was 25 days, and the time of doing tracheostomy was the 9^th day, with the majority occurring at 7-14 days (60.5%). Out of 119 patients, 10 had their intubation successfully removed. The overall mortality rate was 17.6%. Independent risk factors for overall in-hospital mortality included: quantity of comorbid diseases (OR = 2,98, KTC 95% 1,66 – 5,36, p<0,0010), SpO₂ (OR = 0,83, KTC 95% 0,71 – 0,97, p=0,020), chest X-ray with consolidation (OR = 6,63, KTC 95% 1,13 – 38,9, p = 0,036), time of early tracheostomy (OR = 0,25, KTC 95% 0,07 – 0,91, p = 0,036), Conclusion: Patients who received tracheostomy after mechanical ventilation were those with stroke, traumatic brain injury, and pneumonia. The older the patient, the more visible consolidation on the chest X-ray, and the later the time of tracheostomy, the higher the risk of death. Early tracheostomy should be considered for patients to reduce the risk of in-hospital death.