Seymour Christopher W, Halpern Scott, Christie Jason D, Gallop Robert, Fuchs Barry D
Department of Medicine, Hospital of the Universeity of Pennsylvania, Philadelphia 19104, USA
J Intensive Care Med. 2008 Jan-Feb;23(1):52-60. doi: 10.1177/0885066607310302.
Extubation failure is associated with poor intensive care unit and hospital outcomes. Minute ventilation recovery time, an integrative measure of a patient's respiratory reserve, has been shown in a pilot study to predict extubation outcome; however, the methodology is subjective and impractical for routine use. The authors hypothesize that minute ventilation recovery time, measured using an objective and simpler method, would predict extubation outcome. A prospective cohort study was performed in adult medical and surgical intensive care unit patients intubated for >24 hours who were weaning from mechanical ventilation. Minute ventilation recovery time was measured using a new, simplified, and objective method following the final spontaneous breathing trial prior to extubation. The primary outcome was extubation failure, defined as reintubation within 7 days. The study cohort comprised 88 patients, of whom 22 (25%) failed extubation after a median of 3 days. Demographic data, weaning parameters, and the proportion of patients who passed an extubation screen were similar between groups (P > .05). Minute ventilation recovery time was significantly longer in patients who failed extubation (15 [5-15] vs 2 [1-5] minutes, P < .001), consistent in both medical and surgical subgroups. Operating characteristics for a preliminary threshold (minute ventilation recovery time >or=5 minutes) for prediction of extubation failure were sensitivity = 0.78, specificity = 0.71, positive predictive value = 0.47, negative predictive value = 0.90, correctly classified = 0.72. Adjustment for significant covariates did not alter the relationship between minute ventilation recovery time >or=5 minutes and extubation failure (odds ratio = 4.9, 95% confidence interval 1.45-16.2, P < .02). C statistic was 0.79 +/- 0.17. It was concluded that minute ventilation recovery time, measured using a feasible methodology, can predict extubation outcome in medical and surgical intensive care unit patients.
拔管失败与重症监护病房及医院的不良预后相关。分钟通气恢复时间是衡量患者呼吸储备的综合指标，一项初步研究表明其可预测拔管结果；然而，该方法主观性强，不适合常规使用。作者推测，采用客观且更简单的方法测量的分钟通气恢复时间可预测拔管结果。对成年内科和外科重症监护病房中接受机械通气超过24小时且正在撤机的患者进行了一项前瞻性队列研究。在拔管前的最后一次自主呼吸试验后，使用一种新的、简化且客观的方法测量分钟通气恢复时间。主要结局为拔管失败，定义为7天内再次插管。研究队列包括88例患者，其中22例（25%）在中位时间3天后拔管失败。两组间的人口统计学数据、撤机参数以及通过拔管筛查的患者比例相似（P>0.05）。拔管失败患者的分钟通气恢复时间明显更长（15[5 - 15]分钟对2[1 - 5]分钟，P<0.001），在内科和外科亚组中均一致。预测拔管失败的初步阈值（分钟通气恢复时间≥5分钟）的操作特征为：敏感性 = 0.78，特异性 = 0.71，阳性预测值 = 0.47，阴性预测值 = 0.90，正确分类率 = 0.72。对显著协变量进行调整并未改变分钟通气恢复时间≥5分钟与拔管失败之间的关系（优势比 = 4.9，95%置信区间1.45 - 16.2，P<0.02）。C统计量为0.79±0.17。研究得出结论，采用可行方法测量的分钟通气恢复时间可预测内科和外科重症监护病房患者的拔管结果。
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