Medical Intensive Care Unit, AP-HP, Centre Hospitalier Albert Chenevier-Henri Mondor, Créteil, France.
Crit Care Med. 2011 Dec;39(12):2612-8. doi: 10.1097/CCM.0b013e3182282a5a.
Extubation failure is associated with a poor prognosis, but the respective roles for reintubation per se and underlying disease severity remain unclear. Our objectives were to evaluate the impact of failed extubation, whether planned or unplanned, on patient outcomes and to identify a patient subset at risk for extubation failure.
Prospective 1-yr observational study with daily data collection.
: Thirteen-bed medical intensive care unit in a teaching hospital.
Consecutive patients requiring invasive mechanical ventilation were screened and followed until discharge or death.
None.
Of 168 planned extubations in 340 patients, 26 (15%) failed. Of these 26 patients, seven (27%) had pneumonia and 13 (50%) died after reintubation. Compared with successfully extubated patients, the patients with failed extubation were not significantly different regarding disease severity, mechanical ventilation duration, or blood gas values. Age and underlying diseases were the only factors associated with extubation failure, and extubation failure occurred in 34% of patients >65 yrs with chronic cardiac or respiratory disease compared with only 9% of other patients (p < .01). Unplanned extubation occurred in 9% of patients, and inadequate endotracheal tube position was a risk factor. Failure of both planned and unplanned extubation was specifically associated with significant rapid worsening of daily organ dysfunction scores.
Patients >65 yrs with underlying chronic cardiac or respiratory disease are at high risk for extubation failure and subsequent pneumonia and death. Contrasting with successful extubation, failed planned or unplanned extubation was followed by marked clinical deterioration, suggesting a direct and specific effect of extubation failure and reintubation on patient outcomes.
拔管失败与预后不良相关，但重新插管本身和基础疾病严重程度的各自作用仍不清楚。我们的目的是评估计划性或非计划性拔管失败对患者结局的影响，并确定易发生拔管失败的患者亚组。
前瞻性 1 年观察性研究，每日采集数据。
教学医院的 13 张病床的重症监护病房。
连续筛选需要有创机械通气的患者，并进行随访，直至出院或死亡。
无。
在 340 例患者的 168 次计划性拔管中，有 26 次（15%）失败。在这 26 例患者中，有 7 例（27%）患有肺炎，13 例（50%）在重新插管后死亡。与成功拔管的患者相比，拔管失败的患者在疾病严重程度、机械通气时间或血气值方面无显著差异。年龄和基础疾病是唯一与拔管失败相关的因素，有慢性心脏或呼吸系统疾病的 >65 岁患者中，有 34%发生拔管失败，而其他患者仅为 9%（p<.01）。9%的患者发生非计划性拔管，气管插管位置不当是危险因素。计划性和非计划性拔管的失败均与每日器官功能障碍评分的显著迅速恶化相关。
有基础慢性心脏或呼吸系统疾病的 >65 岁患者发生拔管失败以及随后肺炎和死亡的风险较高。与成功拔管相比，计划性或非计划性拔管失败后临床状况明显恶化，提示拔管失败和重新插管对患者结局有直接和特定的影响。
