Buppha Phakapan, Kusumaphanyo Chaiyapruk, Chittawatanarat Kaweesak
J Med Assoc Thai. 2016 Sep;99 Suppl 6:S136-S144.
To identify risk factors associated with extubation failure (EF) in patients admitted to surgical ICUs (SICUs).
Data were gathered during April 2011-January 2013 by collecting demographic, admission details, daily summary, nutritional profile, APACHE II scores, and discharge summary from patients admitted to SICUs among nine university hospitals. Exclusion criteria include pediatric patients, non-consent patients, multiple trauma, cardiovascular and thoracic, and neurosurgical patients. Data were collected to the endpoint of 28 days of admission. Morbidity and mortality were determined. Complications or adverse events that occurred during admission were detailed in separate record forms.
Of 4,652 patients, 2,890 were intubated. Among them, 2,749 were successfully extubated leaving 141 with extubation failure. Overall incidence of EF was 4.88% (with range from 1.41-7.33). Patient characteristics in EF groups were compared to successful groups. Advanced age, presence of congestive heart failure, vascular disease, COPD, emergency surgery, poor APACHE II and SOFA scores, and concurrent use of vasopressors, inotropes and sedatives were significant differences. The most common causes of EF were respiratory failure, inability to cough and laryngeal edema. Outcomes of EF included prolonged length of ICU stay [2 (IQR 1-5) vs. 11 (IQR 6-15) days] and hospital stay [16 (IQR 10-27) vs. 23 (IQR 15-33) days]. Patients with EF were at risk of 6-fold longer ICU stay than successful extubation. Adjusted odds ratio of age, congestive heart failure, emergency surgery, and SOFA score were identified with statistical significance to be risk factors of EF.
EF can affect outcomes of ICU admission. Identifying the risk factors associated with EF will help reduce its incidence and improve ICU outcomes.
确定入住外科重症监护病房（SICU）的患者拔管失败（EF）的相关危险因素。
2011年4月至2013年1月期间，收集了九所大学医院SICU收治患者的人口统计学资料、入院详情、每日总结、营养状况、急性生理与慢性健康状况评分系统（APACHE II）评分及出院总结。排除标准包括儿科患者、不同意参与患者、多发伤患者、心血管和胸科患者以及神经外科患者。数据收集至入院28天的终点。确定发病率和死亡率。入院期间发生的并发症或不良事件在单独的记录表中详细记录。
4652例患者中，2890例进行了插管。其中，2749例成功拔管，141例拔管失败。EF的总体发生率为4.88%（范围为1.41%-7.33%）。将EF组的患者特征与成功组进行比较。高龄、存在充血性心力衰竭、血管疾病、慢性阻塞性肺疾病（COPD）、急诊手术、APACHE II和序贯器官衰竭评估（SOFA）评分较低以及同时使用血管加压药、强心药和镇静剂存在显著差异。EF最常见的原因是呼吸衰竭、无法咳嗽和喉头水肿。EF的结局包括ICU住院时间延长[2（四分位间距1-5）天对11（四分位间距6-15）天]和住院时间延长[16（四分位间距10-27）天对23（四分位间距15-33）天]。EF患者的ICU住院时间比成功拔管患者长6倍。年龄校正比值比、充血性心力衰竭、急诊手术及SOFA评分经统计学分析确定为EF的危险因素。
EF可影响ICU住院结局。识别与EF相关的危险因素将有助于降低其发生率并改善ICU结局。
