老年患者与年龄相关的因素与拔管失败的关系。
Association between age-related factors and extubation failure in elderly patients.
机构信息
Department of Internal Medicine, Division of Geriatric Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
PLoS One. 2018 Nov 20;13(11):e0207628. doi: 10.1371/journal.pone.0207628. eCollection 2018.
BACKGROUND
Elderly patients are being increasingly admitted to the intensive care unit (ICU) for mechanical ventilation. Previous studies demonstrated that 20% to 35% of elderly patients were reintubated within 48 to 72 hours after extubation. Given the age-related physiologic changes and multiple comorbidities in elderly patients, the current conventional parameters for predicting extubation outcomes may not be applicable to this population. This study was performed to identify the association between age-related parameters and extubation failure in elderly patients.
METHODS
Intubated elderly patients (age of ≥60 years) admitted to the medical ICU of a university-based hospital from October 2014 to July 2015 were included. Failed extubation was defined as reintubation within 48 hours after the first extubation. The associations of extubation failure with demographic data, vital signs, cognition and anxiety, and ventilator parameters at the time of intubation and extubation were analyzed.
RESULTS
In total, 127 intubated elderly patients were recruited. Extubation failure occurred in 15 patients (11.8%). Patients with failed extubation had a lower body temperature (37.0°C vs. 37.3°C, P < 0.05) but a higher Facial Anxiety Scale (FAS) score than those with successful extubation (3 vs. 2, P < 0.05). Patients with extubation failure had significantly higher levels of blood urea nitrogen (BUN) (39.88 vs. 58.47 g/dL), serum sodium (137.66 vs. 141.47 mmol/L), and serum calcium (9.52 vs. 10.0 g/dL) but a wider anion gap (12.23 vs. 9.97), but no significant differences in respiratory parameters were found between the two groups. Multiple logistic regression revealed no independent factors associated with successful extubation.
CONCLUSION
This study revealed no strong predictive factors. However, several physiological parameters (lower body temperature and higher FAS scores) and metabolic parameters (BUN, sodium, calcium, and anion gap) were significantly associated with the rate of extubation failure.
背景
越来越多的老年患者因机械通气而被收入重症监护病房（ICU）。先前的研究表明，20%至 35%的老年患者在拔管后 48 至 72 小时内需要再次插管。鉴于老年患者的与年龄相关的生理变化和多种合并症，目前用于预测拔管结果的常规参数可能不适用于该人群。本研究旨在确定与老年患者拔管失败相关的与年龄相关的参数。
方法
纳入 2014 年 10 月至 2015 年 7 月期间入住某大学附属医院内科 ICU 的年龄≥60 岁的插管老年患者。首次拔管后 48 小时内再次插管定义为拔管失败。分析了与插管和拔管时的人口统计学数据、生命体征、认知和焦虑以及呼吸机参数相关的拔管失败的相关性。
结果
共纳入 127 例插管老年患者。15 例（11.8%）患者发生拔管失败。与成功拔管患者相比，拔管失败患者的体温较低（37.0°C 比 37.3°C，P<0.05），但面部焦虑量表（FAS）评分较高（3 比 2，P<0.05）。拔管失败患者的血尿素氮（BUN）水平（39.88 比 58.47g/dL）、血清钠（137.66 比 141.47mmol/L）和血清钙（9.52 比 10.0g/dL）显著升高，而阴离子间隙较宽（12.23 比 9.97），但两组呼吸参数无显著差异。多因素逻辑回归分析未发现与成功拔管相关的独立因素。
结论
本研究未发现强有力的预测因素。然而，一些生理参数（较低的体温和较高的 FAS 评分）和代谢参数（BUN、钠、钙和阴离子间隙）与拔管失败率显著相关。
Zotero 插件