与成功的气管切开术气囊放气相关的临床指标。

Clinical indicators associated with successful tracheostomy cuff deflation.

作者信息

Pryor Lee N, Ward Elizabeth C, Cornwell Petrea L, O'Connor Stephanie N, Chapman Marianne J

机构信息

Royal Adelaide Hospital, Intensive Care Unit, SA, Australia; The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia.

The University of Queensland, School of Health & Rehabilitation Sciences, QLD, Australia; Centre for Functioning & Health Research (CFAHR), QLD, Australia.

出版信息

Aust Crit Care. 2016 Aug;29(3):132-7. doi: 10.1016/j.aucc.2016.01.002. Epub 2016 Feb 23.

DOI:10.1016/j.aucc.2016.01.002

PMID:26920443

Abstract

BACKGROUND

Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown.

OBJECTIVES

The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort.

METHODS

A retrospective review of 113 acutely tracheostomised patients with a subglottic suction tube in situ was conducted.

RESULTS

Ninety-five percent of patients (n=107) achieved continuous cuff deflation on the first attempt. The clinical observations recorded as present in the 24h preceding cuff deflation included: (1) medical stability, (2) respiratory stability, (3) fraction of inspired oxygen ≤0.4, (4) tracheal suction ≤1-2 hourly, (5) sputum thin and easy to suction, (6) sputum clear or white, (7) ≥moderate cough strength, (8) above cuff secretions ≤1ml per hour and (9) alertness≥eyes open to voice. Using the presence of all 9 indicators as predictors of successful cuff deflation tolerance, specificity and positive predictive value were 100%, although sensitivity was only 77% and negative predictive value 19%. Refinement to a set of 3 clinically driven criteria (medical and respiratory stability, above cuff secretions ≤1ml/h) provided high specificity (100%), sensitivity (95%), positive predictive value (100%) and an improved negative predictive value (55%).

CONCLUSIONS

Key criteria can help guide clinical decision-making on patient readiness for cuff deflation.

摘要

背景

气管造口术套管放气是拔管过程中的一个必要阶段，但目前尚不清楚指导套管成功放气的最佳临床指标。

目的

本研究旨在确定：（1）首次尝试时能耐受持续套管放气的患者比例；（2）与套管放气成功或失败相关的临床观察指标，包括套管上方分泌物量；（3）这些观察指标在异质性队列中的预测能力。

方法

对113例急性气管造口且声门下置有吸引管的患者进行回顾性研究。

结果

95%的患者（n = 107）首次尝试即实现持续套管放气。套管放气前24小时记录的存在的临床观察指标包括：（1）病情稳定；（2）呼吸稳定；（3）吸入氧分数≤0.4；（4）气管吸引每小时≤1 - 2次；（5）痰液稀薄且易于吸引；（6）痰液清亮或呈白色；（7）咳嗽强度≥中度；（8）套管上方分泌物每小时≤1ml；（9）警觉性≥对声音有睁眼反应。将所有9项指标作为成功耐受套管放气的预测指标时，特异性和阳性预测值均为100%，但敏感性仅为77%，阴性预测值为19%。优化为一组3项由临床驱动的标准（病情和呼吸稳定、套管上方分泌物≤1ml/h）后，特异性为100%，敏感性为95%，阳性预测值为100%，阴性预测值提高到55%。