计划性拔管后无创通气的效果。

Effect of Noninvasive Ventilation After Unplanned Extubation.

机构信息

Réanimation polyvalente et surveillance continue, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Hôpitaux universitaires Paris Sud, Clamart, France.

Institut National de la Santé et de la Recherche Médicale U999, Centre Chirurgical Marie Lannelongue, Université Paris Sud, Le Plessis Robinson, France.

出版信息

Respir Care. 2019 Mar;64(3):248-254. doi: 10.4187/respcare.06328. Epub 2018 Nov 6.

DOI:10.4187/respcare.06328

PMID:30401754

Abstract

BACKGROUND

Our study set out to test the effect of noninvasive ventilation (NIV) performed after unplanned extubation.

METHODS

Retrospective analysis of prospectively collected data in a university-affiliated mixed ICU of 12 beds during a 5-y period (January 2013 to December 2017). Unplanned extubation was defined as the occurrence of an unplanned removal of the endotracheal tube, whether deliberate or accidental. NIV after an unplanned extubation was not protocolized and was decided by the physician in charge on an individual basis.

RESULTS

A total of 121 subjects (median [25th-75th percentile] age, 62.1 [43.3-73.6] y; median [25th-75th percentile] Simplified Acute Physiology Score II, 45 [36-54]) experienced 131 unplanned extubation episodes. Re-intubation was deemed necessary in 35 subjects (28.9%). NIV was used in 24 subjects (19.8%) (prophylactic NIV, = 10; rescue NIV, = 14). The re-intubation rates were 25.8%, 10%, and 64.3% in the no NIV, prophylactic, and rescue NIV subgroups, respectively. The median (25th-75th percentile) time to re-intubation was longer for subjects on NIV (9.1 [3.5-49.2] vs 0.46 [0.25-1] h, = .001). The median (25th-75th percentile) ICU length of stay and duration of mechanical ventilation were longer in the subjects who underwent NIV (14.5 [7-24.5] vs 6 [3-14] d, respectively, = .004; and 9 [3-22] vs 3 [1-7.3] d, respectively, = .003).

CONCLUSIONS

NIV after unplanned extubation had uncertain efficacy, especially when provided as rescue management of postextubation respiratory failure.

摘要

背景

本研究旨在测试计划性拔管后行无创通气（NIV）的效果。

方法

回顾性分析 5 年间（2013 年 1 月至 2017 年 12 月）一所大学附属医院 12 张混合 ICU 前瞻性收集的数据。计划性拔管被定义为气管插管的意外或非计划性移除。计划性拔管后行 NIV 并无固定方案，由主管医生根据具体情况决定。

结果

共 121 名患者（中位数 [25 百分位数-75 百分位数]年龄，62.1 [43.3-73.6]岁；中位数 [25 百分位数-75 百分位数]简化急性生理学评分 II，45 [36-54]）经历了 131 次计划性拔管。35 名患者（28.9%）需要重新插管。24 名患者（19.8%）使用了 NIV（预防性 NIV， = 10；抢救性 NIV， = 14）。未行 NIV、预防性 NIV 和抢救性 NIV 亚组的再插管率分别为 25.8%、10%和 64.3%。行 NIV 的患者再插管时间中位数（25 百分位数-75 百分位数）较长[9.1 [3.5-49.2] vs 0.46 [0.25-1] h， =.001]。行 NIV 的患者 ICU 住院时间和机械通气时间中位数（25 百分位数-75 百分位数）较长[分别为 14.5 [7-24.5] vs 6 [3-14] d， =.004；9 [3-22] vs 3 [1-7.3] d， =.003]。