Intensive Care, Department of Intensive Care, Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, 6500, Bellinzona, Switzerland.
Intensive Care Med. 2010 Dec;36(12):2045-52. doi: 10.1007/s00134-010-1984-4. Epub 2010 Aug 6.
The spontaneous breathing trial (SBT)-relying on objective criteria assessed by the clinician-is the major diagnostic tool to determine if patients can be successfully extubated. However, little is known regarding the patient's subjective perception of autonomous breathing.
We performed a prospective observational study in 211 mechanically ventilated adult patients successfully completing a SBT. Patients were randomly assigned to be interviewed during this trial regarding their prediction of extubation success. We compared post-extubation outcomes in three patient groups: patients confident (confidents; n = 115) or not (non-confidents; n = 38) of their extubation success and patients not subjected to interview (control group; n = 58).
Extubation success was more frequent in confidents than in non-confidents (90 vs. 45%; p < 0.001/positive likelihood ratio = 2.00) or in the control group (90 vs. 78%; p = 0.04). On the contrary, extubation failure was more common in non-confidents than in confidents (55 vs. 10%; p < 0.001/negative likelihood ratio = 0.19). Logistic regression analysis showed that extubation success was associated with patient's prediction [OR (95% CI): 9.2 (3.74-22.42) for confidents vs.non-confidents] as well as to age [0.72 (0.66-0.78) for age 75 vs. 65 and 1.31 (1.28-1.51) for age 55 vs. 65].
Our data suggest that at the end of a sustained SBT, extubation success might be correlated to the patients' subjective perception of autonomous breathing. The results of this study should be confirmed by a large multicenter trial.
依靠临床医生评估的客观标准进行的自主呼吸试验（SBT）是确定患者是否可以成功拔管的主要诊断工具。然而，对于患者对自主呼吸的主观感知知之甚少。
我们对 211 例成功完成 SBT 的机械通气成年患者进行了前瞻性观察研究。患者在该试验期间被随机分配接受采访，以了解他们对拔管成功的预测。我们比较了三组患者的拔管后结局：对拔管成功有信心的患者（confidents；n = 115）或没有信心的患者（non-confidents；n = 38）以及未接受采访的患者（对照组；n = 58）。
与 non-confidents（90%比 45%；p < 0.001/阳性似然比=2.00）或对照组（90%比 78%；p = 0.04）相比，confidents 组的拔管成功率更高。相反，non-confidents 组的拔管失败率更高（55%比 10%；p < 0.001/阴性似然比=0.19）。Logistic 回归分析显示，拔管成功与患者的预测有关[比值比（95%CI）：confidents 比 non-confidents 为 9.2（3.74-22.42）]，也与年龄有关[75 岁比 65 岁为 0.72（0.66-0.78），55 岁比 65 岁为 1.31（1.28-1.51）]。
我们的数据表明，在持续 SBT 结束时，拔管成功可能与患者对自主呼吸的主观感知有关。这项研究的结果应该通过一项大型多中心试验来证实。
