Division of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2020 Oct;36(10):841-849. doi: 10.1002/kjm2.12269. Epub 2020 Jul 30.
Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten the MV duration and potentially reduce MV-related complications. Therefore, prediction of patients who can successfully be weaned from the mechanical ventilator is an important issue. The electronic medical record system (EMRs) has been applied and developed in respiratory therapy in recent years. It can increase the quality of critical care. However, there is no perfect index available that can be used to determine successful MV weaning. Our purpose was to establish a novel model that can predict successful weaning from MV. Patients' information was collected from the Kaohsiung Medical University Hospital respiratory therapy EMRs. In this retrospective study, we collected basic information, classic weaning index, and respiratory parameters during spontaneous breathing trials of patients eligible for extubation. According to the results of extubation, patients were divided into successful extubation and extubation failure groups. This retrospective cohort study included 169 patients. Statistical analysis revealed successful extubation predictors, including sex; height; oxygen saturation; Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II score; pulmonary disease history; and the first, 30th, 60th, and 90th minute respiratory parameters. We built a predictive model based on these predictors. The area under the curve of this model was 0.889. We established a model for predicting the successful extubation. This model was novel to combine with serial weaning parameters and thus can help intensivists to make extubation decisions easily.
机械通气(MV)是重症监护病房中常用的生命支持系统。准确识别能够拔管的患者可以缩短 MV 持续时间,并可能降低 MV 相关并发症的风险。因此,预测能够成功脱离机械呼吸机的患者是一个重要问题。电子病历系统(EMRs)近年来已在呼吸治疗中得到应用和发展。它可以提高重症监护的质量。然而,目前还没有一个完美的指标可以用来确定 MV 脱机的成功。我们的目的是建立一个新的模型,可以预测 MV 的成功脱机。患者信息从高雄医学大学附属医院呼吸治疗 EMR 中收集。在这项回顾性研究中,我们收集了符合拔管条件的患者的基本信息、经典脱机指标和自主呼吸试验期间的呼吸参数。根据拔管结果,将患者分为成功拔管和拔管失败组。这项回顾性队列研究共纳入 169 名患者。统计分析揭示了成功拔管的预测因素,包括性别、身高、血氧饱和度、格拉斯哥昏迷评分、急性生理学和慢性健康评估 II 评分、肺部疾病史,以及第 1、30、60 和 90 分钟的呼吸参数。我们基于这些预测因素构建了一个预测模型。该模型的曲线下面积为 0.889。我们建立了一个预测成功拔管的模型。该模型将多个参数相结合,具有创新性,有助于重症监护医生更轻松地做出拔管决策。