Department of Critical Care Medicine, B and C Medical College, Teaching Hospital and Research Center, Birtamod, Nepal.
Department of Anesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
J Nepal Health Res Counc. 2020 Apr 19;18(1):21-26. doi: 10.33314/jnhrc.v18i1.2114.
Arterial blood gas is required for extubation decision after spontaneous breathing trial in most of intensive care unit. This study was conducted to assess the influence of arterial blood gas for extubation after successful spontaneous breathing trial in intensive care unit patients planned for extubation.
It was prospective observation study conducted in all patients of age greater than eighteen year admitted in intensive care unit of tertiary care hospital for one year. It was done in 108 patients who were planned for extubation. Patients were assessed by intensivist clinically and decided whether a patient can be extubated on clinical grounds. Spontaneous breathing trial was done for 2 hours by t-piece in patients who met clinical and objective criteria. Arterial blood gas was done in all patients who successfully completed spontaneous breathing trial. Patients with successful spontaneous breathing trial, acceptable arterial blood gas were extubated. Independent Student's t test and paired t test was used for data analysis.
Out of 108 patients who passed the spontaneous breathing trial, 96(88.88%) patients had acceptable arterial blood gas and were extubated and 12(11.11%) patients did not have acceptable arterial blood gas level and were chosen to have other mode of weaning.
This study demonstrates that arterial blood gas level has changed decision for extubation after successful spontaneous breathing trial. Further, arterial blood gas might help in identification of patients who can undergo extubation failure when rapid shallow breathing index failed to predict outcome of extubation.
在大多数重症监护病房中，自主呼吸试验后拔管决策需要进行动脉血气分析。本研究旨在评估动脉血气分析对计划拔管的重症监护病房患者自主呼吸试验成功后的拔管影响。
这是一项在一家三级护理医院重症监护病房中进行的为期一年的前瞻性观察研究，共纳入 108 名计划拔管的患者。由重症监护医生进行临床评估，根据临床和客观标准决定患者是否可以基于临床理由拔管。符合临床和客观标准的患者通过 T 型管进行 2 小时自主呼吸试验。所有成功完成自主呼吸试验的患者均进行动脉血气分析。成功完成自主呼吸试验且动脉血气可接受的患者进行拔管。数据分析采用独立样本 t 检验和配对 t 检验。
在通过自主呼吸试验的 108 名患者中，96 名（88.88%）患者的动脉血气可接受并进行了拔管，12 名（11.11%）患者的动脉血气水平不可接受，选择了其他脱机方式。
本研究表明，动脉血气水平改变了自主呼吸试验成功后的拔管决策。此外，当快速浅呼吸指数未能预测拔管结局时，动脉血气分析可能有助于识别可能发生拔管失败的患者。
