Department of Anesthesiology, Mercy St Vincent Medical Center, Toledo, OH 48109, USA.
J Crit Care. 2013 Feb;28(1):69-76. doi: 10.1016/j.jcrc.2012.09.002. Epub 2012 Nov 14.
Extubation failure is associated with worse outcomes. Physicians use respiratory parameters to help them to decide to extubate or not. The purpose of this study is to determine if novel measures of respiratory physiology such as complexity and variability can identify patients who will tolerate extubation.
Eighty-three patients who required reinstitution of mechanical ventilation after extubation (Extub-Fail) were matched to 83 patients who successfully tolerated extubation (Extub-Success) and to 83 who failed a spontaneous breathing trial (SBT-Fail). Patients were compared using interbreath intervals and tidal volumes using means, SDs, measures of complexity, spikiness, and rapid shallow breathing index (RSBI).
From SBT-Fail to Extub-Fail to Extub-Success, the interbreath intervals progressively lengthened (mean ± SD, 2.2 seconds ± 0.6 vs 2.5 ± 0.6 vs 2.7 ± 0.8; P < .001), became more variable (mean ± SD, 0.57 ± 0.13 vs 0.62 ± 0.21 vs 0.66 ± 0.23; P = .012), and became more complex. Complexity as measured by approximate and sample entropy was greater in the Extub-Success group than in the SBT-Fail group. Patients who were in the SBT-Fail group had a higher RSBI than did either of the extubated groups, but there was no difference in RSBI between Extub-Success and Extub-Fail.
Patients who successfully tolerate extubation have longer interbreath interval with greater complexity and variability of that series. Although the V(T) was similar between the Extub-Success and the SBT-Fail groups, the Extub-Success group had greater long-term complexity with no difference in short-term complexity. This implies that the respiratory controllers are differently impacted in patients tolerating or not tolerating extubation.
拔管失败与更差的结局相关。医生使用呼吸参数来帮助他们决定是否拔管。本研究的目的是确定呼吸生理的新测量方法，如复杂性和可变性，是否可以识别能够耐受拔管的患者。
83 例拔管后需要重新机械通气的患者（拔管失败组）与 83 例成功耐受拔管的患者（拔管成功组）和 83 例自主呼吸试验失败的患者（自主呼吸试验失败组）进行匹配。使用平均、标准差、复杂性、尖锐度和快速浅呼吸指数（RSBI）测量呼吸暂停间隔和潮气量，对患者进行比较。
从自主呼吸试验失败到拔管失败到拔管成功，呼吸暂停间隔逐渐延长（平均值±标准差，2.2 秒±0.6 比 2.5±0.6 比 2.7±0.8；P＜0.001），变得更具变异性（平均值±标准差，0.57±0.13 比 0.62±0.21 比 0.66±0.23；P=0.012），变得更复杂。拔管成功组的近似熵和样本熵复杂度均高于自主呼吸试验失败组。自主呼吸试验失败组的 RSBI 高于任何拔管组，但拔管成功组与拔管失败组之间的 RSBI 无差异。
成功耐受拔管的患者呼吸暂停间隔更长，且该序列的复杂性和变异性更大。尽管拔管成功组和自主呼吸试验失败组的潮气量相似，但拔管成功组的长期复杂性更大，短期复杂性无差异。这表明在耐受或不耐受拔管的患者中，呼吸控制器受到的影响不同。
