友敌：手术和创伤患者再次插管的风险因素的前瞻性评估。

FRIEND or FOE: A prospective evaluation of risk factors for reintubation in surgical and trauma patients.

机构信息

Department of Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, United States.

出版信息

Am J Surg. 2018 Dec;216(6):1056-1062. doi: 10.1016/j.amjsurg.2018.07.004. Epub 2018 Jul 10.

DOI:10.1016/j.amjsurg.2018.07.004

PMID:30017306

Abstract

BACKGROUND

A Form for Re-Intubation Evaluation by Nurses and Doctors (FRIEND) was used to prospectively collect pre-extubation data, to determine failure of extubation (FOE) risk.

METHODS

FRIENDs, including airway, breathing, and neurologic variables, were completed before extubation on trauma & surgical patients in one ICU from 1/1/16 to 5/31/17. Those with failed vs. successful extubation were compared. We excluded those with tracheostomy, comfort measures, or death before extubation.

RESULTS

There were 464 eligible extubations in 436 patients. Thirty five reintubations (7.9% FOE rate) occurred in 32 patients within 96 h of extubation. FOE patients had higher ICU days (6 d vs. 2 d), ventilator days (6 d vs. 2 d), and mortality (15.6% vs. 2.7%) [all p < 0.001] compared to those without FOE. Odds of FOE (OR [CI]) increased with age (1.03, [1, 1.06]), delirium (3, [1.16, 7.76]), moderate/copious secretions (3.95, [1.46, 10.66]), and enteral opioid use (4.23, [1.28, 14.02]).

CONCLUSIONS

Several characteristics present at the time of extubation were risk factors for FOE in trauma and surgical patients. Patients with FOE had higher mortality.

摘要

背景

护士和医生使用重新插管评估表（FRIEND）前瞻性地收集拔管前数据，以确定拔管失败（FOE）的风险。

方法

在 2016 年 1 月 1 日至 2017 年 5 月 31 日期间，在一个 ICU 中对创伤和外科患者进行 FRIEND 评估，包括气道、呼吸和神经系统变量。对拔管成功与失败的患者进行比较。我们排除了那些有气管造口术、舒适措施或在拔管前死亡的患者。

结果

在 436 名患者中，有 464 例符合条件的拔管。在 96 小时内，有 32 名患者有 35 例再次插管（7.9%的 FOE 率）。FOE 患者的 ICU 天数（6 天比 2 天）、呼吸机天数（6 天比 2 天）和死亡率（15.6%比 2.7%）均高于无 FOE 患者（均 P<0.001）。FOE 的可能性（OR [CI]）随着年龄（1.03 [1, 1.06]）、谵妄（3 [1.16, 7.76]）、中量/大量分泌物（3.95 [1.46, 10.66]）和肠内阿片类药物使用（4.23 [1.28, 14.02]）的增加而增加。