Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
PLoS One. 2020 Mar 10;15(3):e0229935. doi: 10.1371/journal.pone.0229935. eCollection 2020.
Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution.
We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days.
Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2-61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34-4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50-3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18-2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution.
The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards.
在成功撤机后，气管切开患者的机械通气（MV）可能会重新开始，因为护理环境从重症监护病房转变为普通病房。本研究旨在调查 MV 重新开始的发生、后果和相关因素。
我们分析了从撤机病房出院到普通病房的气管切开患者的临床数据和生理测量值，以比较在 60 天内有无院内 MV 重新开始的患者之间的差异。
在 454 例成功撤机的患者中，116 例（25.6%）在 60 天内重新开始 MV；在出院时，42 例（36.2%）最终脱离 MV，51 例（44.0%）仍依赖 MV，33 例（28.4%）死亡。在 60 天内无重新开始 MV 的 338 例患者中，只有 3 例（0.9%）在出院前（分别在普通病房第 67、89 和 136 天）再次开始 MV，322 例（95.2%）再次成功撤机，13 例（3.8%）死亡。与未重新开始 MV 的患者相比，重新开始 MV 的患者在自主呼吸试验前的最大呼气压力（PEmax）明显较低。多变量 Cox 回归分析显示，RCC 出院时发热（危险比[HR]14.00，95%置信区间[CI]3.2-61.9）、慢性阻塞性肺疾病（HR 2.37，95%CI 1.34-4.18）、ICU 时肾脏替代治疗（HR 2.29，95%CI 1.50-3.49）和气管切开前拔管失败（HR 1.76，95%CI 1.18-2.63）与重新开始 MV 的风险增加相关，而 PEmax >30cmH2O（HR 0.51，95%CI 0.35-0.76）与重新开始 MV 的风险降低相关。
普通病房重新开始 MV 的发生率较高，预后较差。在自主呼吸试验前测量的 PEmax 与普通病房重新开始 MV 的风险显著相关。
