1 Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung City, Taiwan.
2 School of Nursing, National Taiwan University (NTU) Medical College and NTU Hospital, Taipei, Taiwan.
J Intensive Care Med. 2019 Aug;34(8):640-645. doi: 10.1177/0885066617706688. Epub 2017 Apr 26.
Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients' alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI.
This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes.
Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ≤ 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, = .026).
The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU.
在呼吸预测指标中，快速浅呼吸指数（RSBI）已被广泛应用于预测拔管结局。然而，预测结果仍不一致。关于非呼吸预测指标，有报道称血清白蛋白、血红蛋白、碳酸氢盐和患者意识状态与成功撤机或拔管相关。我们旨在建立一个整合指数，结合成人重症监护病房（MICU）中常用的预测指标，并比较该指数与 RSBI 的预测能力。
这是一项前瞻性观察研究，回顾性收集计划拔管的患者数据。我们纳入了在成人 MICU 中接受经气管插管机械通气>24 小时、通过 2 小时自主呼吸试验且行拔管的患者。拔管失败定义为拔管后 48 小时内重新行有创机械通气。前瞻性记录患者的呼吸参数和格拉斯哥昏迷评分（GCS）。回顾性记录非呼吸参数。使用逻辑回归确定拔管结局的显著预测因素。
共纳入 59 例患者，共 70 次拔管。拔管失败与较低的血清白蛋白（白蛋白<2.6 g/dL，比值比[OR] = 5.1；95%置信区间[CI]，1.04-24.66）、较低的血红蛋白（血红蛋白<10.0 g/dL，OR = 10.8；95%CI，2.00-58.04）和较低的 GCS 评分（GCS 评分≤8，OR = 6.1；95%CI = 1.15-32.34）显著相关。通过将这 3 个参数整合在一起建立一个综合指数，该指数预测拔管结局的敏感性和特异性分别为 78.6%和 75.9%。该指数的受试者工作特征曲线下面积明显高于 RSBI（0.84 比 0.61，=0.026）。
在成人 MICU 中，结合血清白蛋白、血红蛋白和 GCS 评分的综合指数可以比 RSBI 更好地预测拔管结局。
