Chao Chien-Ming, Lai Chih-Cheng, Cheng Ai-Chin, Chiang Shyh-Ren, Liu Wei-Lun, Ho Chung-Han, Hsing Shu-Chen, Chen Chin-Ming, Cheng Kuo-Chen
Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan.
Departments of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
PLoS One. 2017 Aug 16;12(8):e0183360. doi: 10.1371/journal.pone.0183360. eCollection 2017.
We investigated failure predictors for the planned extubation of overweight (body mass index [BMI] = 25.0-29.9) and obese (BMI ≥ 30) patients. All patients admitted to the adult intensive care unit (ICU) of a tertiary hospital in Taiwan were identified. They had all undergone endotracheal intubation for > 48 h and were candidates for extubation. During the study, 595 patients (overweight = 458 [77%]); obese = 137 [23%]) with planned extubation after weaning were included in the analysis; extubation failed in 34 patients (5.7%). Their mean BMI was 28.5 ± 3.8. Only BMI and age were significantly different between overweight and obese patients. The mortality rate for ICU patients was 0.8%, and 2.9% for inpatients during days 1-28; the overall in-hospital mortality rate was 8.4%. Failed Extubation group patients were significantly older, had more end-stage renal disease (ESRD), more cardiovascular system-related respiratory failure, higher maximal inspiratory pressure (MIP), lower maximal expiratory pressure (MEP), higher blood urea nitrogen, and higher ICU- and 28-day mortality rates than did the Successful Extubation group. Multivariate logistic regression showed that cardiovascular-related respiratory failure (odds ratio [OR]: 2.60; 95% [confidence interval] CI: 1.16-5.80), ESRD (OR: 14.00; 95% CI: 6.25-31.35), and MIP levels (OR: 0.94; 95% CI: 0.90-0.97) were associated with extubation failure. We conclude that the extubation failure risk in overweight and obese patients was associated with cardiovascular system-related respiratory failure, ESRD, and low MIP levels.
我们研究了超重（体重指数[BMI]=25.0 - 29.9）和肥胖（BMI≥30）患者计划拔管的失败预测因素。纳入了台湾一家三级医院成人重症监护病房（ICU）收治的所有患者。他们均接受气管插管超过48小时且为拔管候选人。研究期间，595例计划撤机后拔管的患者（超重=458例[77%]；肥胖=137例[23%]）纳入分析；34例患者（5.7%）拔管失败。他们的平均BMI为28.5±3.8。超重和肥胖患者之间仅BMI和年龄存在显著差异。ICU患者的死亡率为0.8%，住院1 - 28天期间住院患者的死亡率为2.9%；总体院内死亡率为8.4%。与成功拔管组相比，拔管失败组患者年龄显著更大，患有终末期肾病（ESRD）的更多，心血管系统相关呼吸衰竭更多，最大吸气压力（MIP）更高，最大呼气压力（MEP）更低，血尿素氮更高，ICU及28天死亡率更高。多因素逻辑回归显示，心血管相关呼吸衰竭（比值比[OR]：2.60；95%[置信区间]CI：1.16 - 5.80）、ESRD（OR：14.00；95%CI：6.25 - 31.35）和MIP水平（OR：0.94；95%CI：0.90 - 0.97）与拔管失败相关。我们得出结论，超重和肥胖患者的拔管失败风险与心血管系统相关呼吸衰竭、ESRD及低MIP水平有关。
