Navalesi Paolo, Frigerio Pamela, Moretti Maria Pia, Sommariva Maurizio, Vesconi Sergio, Baiardi Paola, Levati Anna
Department of Anesthesia and Intensive Care Medicine, Intensive Care Unit, Universit Hospital Maggiore della Carità, Eastern Piedmont University, Novara, Italy.
Crit Care Med. 2008 Nov;36(11):2986-92. doi: 10.1097/CCM.0b013e31818b35f2.
To assess whether a systematic approach to weaning and extubation (intervention) is superior to the sole physician's judgment (control) in preventing reintubation secondary to extubation failure in patients with neurologic disorders.
Randomized controlled trial.
Intensive care unit of a large teaching hospital.
Three hundred eighteen intubated patients who had been receiving mechanical ventilation for at least 12 hrs and were able to trigger the ventilator.
Patients were randomized to the intervention (n = 165) or control group (n = 153).
Rate of reintubation after extubation failure occurring within 48 hrs (primary end point). Duration of mechanical ventilation, length of intensive care unit stay, mortality, rate of tracheotomy (secondary end points). The perception of the research protocol by the intensive care unit staff was also assessed.
The rate of reintubation was lower in the intervention (5%) than in the control (12.5%) group (p = 0.047). There was no difference in any of the other outcome variables (secondary end points). Simplified Acute Physiologic Score II (adjusted odds ratio 1.042 per unit; 95% confidence interval 1.006-1.080; p = 0.022) and inclusion in the control group (adjusted odds ratio 2.393; 95% confidence interval 1.000-5.726; p = 0.05) were the only two independent predictive factors for the risk of extubation failure. The protocol was felt by the staff to determine an improvement in patients' clinical outcome, but to increase intensive care unit workload; nurses and physiotherapists considered its impact on their professional role more positively than physicians.
In patients with neurologic diseases, a systematic approach to weaning and extubation reduces the rate of reintubation secondary to extubation failure without affecting the duration of mechanical ventilation, and is overall positively perceived by intensive care unit professionals.
评估在预防神经系统疾病患者因拔管失败导致再次插管方面，系统化的撤机和拔管方法（干预措施）是否优于单纯医生的判断（对照措施）。
随机对照试验。
一家大型教学医院的重症监护病房。
318例接受机械通气至少12小时且能够触发呼吸机的插管患者。
患者被随机分为干预组（n = 165）和对照组（n = 153）。
拔管失败后48小时内再次插管的发生率（主要终点）。机械通气时间、重症监护病房住院时间、死亡率、气管切开率（次要终点）。还评估了重症监护病房工作人员对研究方案的看法。
干预组再次插管的发生率（5%）低于对照组（12.5%）（p = 0.047）。其他任何结局变量（次要终点）均无差异。简化急性生理学评分II（每单位调整优势比1.042；95%置信区间1.006 - 1.080；p = 0.022）和纳入对照组（调整优势比2.393；95%置信区间1.000 - 5.726；p = 0.05）是拔管失败风险仅有的两个独立预测因素。工作人员认为该方案能改善患者临床结局，但会增加重症监护病房的工作量；护士和物理治疗师对其对自身专业角色的影响的看法比医生更为积极。
对于神经系统疾病患者，系统化的撤机和拔管方法可降低因拔管失败导致的再次插管发生率，且不影响机械通气时间，总体上得到了重症监护病房专业人员的积极认可。
