Lee Ye Jin, Lee Jinwoo, Lee Sang-Min, Cho Jaeyoung
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Acute Crit Care. 2020 Nov;35(4):271-278. doi: 10.4266/acc.2020.00479. Epub 2020 Nov 12.
Before the main trial in which respiratory polygraphy will be used to evaluate postextubation sleep apnea in critically ill patients, we performed a prospective pilot study to ensure that any issues with the conduct of the trial would be identified.
In the present study, 13 adult patients who had received mechanical ventilation for ≥24 hours were prospectively recruited. Among the patients, 10 successfully completed respiratory polygraphy on the first or second night after extubation. Data regarding the types and doses of corticosteroids, analgesics, sedatives, and muscle relaxants as well as the methods of oxygen delivery were recorded.
During the night of respiratory polygraphy, all 10 patients received supplemental oxygen (low-flow oxygen, n=5; high-flow oxygen, n=5), and seven patients received intravenous corticosteroids. Three of the 10 patients had a respiratory event index (REI) ≥5/hr. All respiratory events were obstructive episodes. None of the patients receiving high-flow oxygen therapy had an REI ≥5/hr. Two of the seven patients who received corticosteroids and one of the other three patients who did not receive this medication had an REI ≥5/hr. Although low- or high-flow oxygen therapy was provided, all patients had episodes of oxygen saturation (SpO2) <90%. Two of the three patients with an REI ≥5/hr underwent in-laboratory polysomnography. The patients' Apnea-Hypopnea Index and REI obtained via polysomnography and respiratory polygraphy, respectively, were similar.
In a future trial to evaluate postextubation sleep apnea in critically ill patients, pre-stratification based on the use of corticosteroids and high-flow oxygen therapy should be considered.
在将呼吸多导睡眠图用于评估重症患者拔管后睡眠呼吸暂停的主要试验之前，我们进行了一项前瞻性试点研究，以确保识别出试验实施过程中的任何问题。
在本研究中，前瞻性招募了13名接受机械通气≥24小时的成年患者。其中，10名患者在拔管后的第一晚或第二晚成功完成了呼吸多导睡眠图检查。记录了有关皮质类固醇、镇痛药、镇静剂和肌肉松弛剂的类型和剂量以及氧气输送方法的数据。
在呼吸多导睡眠图检查当晚，所有10名患者均接受了补充氧气（低流量氧气，n = 5；高流量氧气，n = 5），7名患者接受了静脉注射皮质类固醇。10名患者中有3名呼吸事件指数（REI）≥5次/小时。所有呼吸事件均为阻塞性发作。接受高流量氧气治疗的患者中，无一例REI≥5次/小时。接受皮质类固醇治疗的7名患者中有2名以及未接受该药物治疗的其他3名患者中有1名REI≥5次/小时。尽管提供了低流量或高流量氧气治疗，但所有患者均有血氧饱和度（SpO2）<90%的发作。3名REI≥5次/小时的患者中有2名接受了实验室多导睡眠图检查。通过多导睡眠图和呼吸多导睡眠图分别获得的患者呼吸暂停低通气指数和REI相似。
在未来评估重症患者拔管后睡眠呼吸暂停的试验中，应考虑根据皮质类固醇的使用和高流量氧气治疗进行预分层。
