Hsiung Lee Eric Shih, Jiann Lim Danny Tse, Taculod Juvel Mabao, Sahagun Juliet Tolentino, Otero Joerie Pasive, Teo Kaimin, Loh Will Ne-Hooi, Hui Tan Addy Yong
Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore.
Department of Anesthesia, Singapore General Hospital, Outram Road, Singapore.
Indian J Crit Care Med. 2017 Mar;21(3):131-137. doi: 10.4103/ijccm.IJCCM_452_16.
The objective of the study was to determine the incidence of failed extubations in our Intensive Care Unit (ICU) and identify associated clinical factors.
A prospective observational study of mechanically ventilated patients who underwent extubation attempts in our (predominantly surgical) ICU was undertaken from July 2012 to August 2013. The primary endpoint was the need for nonelective reintubation within 72 h of extubation. Clinical data of the reintubated patients were compared with those who were successfully extubated to identify factors associated with reintubation.
Five hundred and eight extubation attempts were documented, 38 (7.5%) of which were unsuccessful. On multivariate analysis, the following clinical factors were found to be associated with an increased risk of failed extubation: unplanned extubations (adjusted odds ratio [OR] 5.8), the use of noninvasive ventilation (NIV) postextubation (adjusted OR 3.2), and sepsis (adjusted OR 2.9). Patient demographic factors, other premorbid and comorbid medical conditions, and differences of laboratory parameters did not appear to significantly influence reintubation rates in our study.
Our study has demonstrated a relatively low reintubation rate, likely due to inclusion of elective admissions/intubations in our patient population. Unplanned extubations, the use of NIV postextubation, and sepsis were associated with increased reintubation risk, reinforcing the need for increased vigilance in this subgroup of patients after extubation.
本研究的目的是确定我们重症监护病房（ICU）拔管失败的发生率，并识别相关临床因素。
2012年7月至2013年8月，对我们（主要是外科）ICU中接受拔管尝试的机械通气患者进行了一项前瞻性观察研究。主要终点是拔管后72小时内非选择性再次插管的必要性。将再次插管患者的临床数据与成功拔管患者的数据进行比较，以确定与再次插管相关的因素。
记录了508次拔管尝试，其中38次（7.5%）未成功。多因素分析发现，以下临床因素与拔管失败风险增加相关：意外拔管（调整后的优势比[OR]为5.8）、拔管后使用无创通气（NIV）（调整后的OR为3.2）和脓毒症（调整后的OR为2.9）。在我们的研究中，患者人口统计学因素、其他病前和合并的医疗状况以及实验室参数差异似乎对再次插管率没有显著影响。
我们的研究显示再次插管率相对较低，这可能是由于我们的患者群体纳入了择期入院/插管患者。意外拔管、拔管后使用NIV和脓毒症与再次插管风险增加相关，这进一步强调了对该亚组患者拔管后需提高警惕。
