Savla Paras, Toor Harjyot, Podkovik Stacey, Mak Joseph, Kal Sarala, Soliman Chantal, Ku Andrew, Majeed Gohar, Miulli Dan E
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Internal Medicine, University of California Riverside School of Medicine, Riverside, USA.
Cureus. 2021 Jan 6;13(1):e12539. doi: 10.7759/cureus.12539.
Background and purpose Patients with spontaneous intracerebral haemorrhage have significant morbidity and mortality. One aspect of their care is the need for mechanical ventilation. Extubating a patient safely and efficiently is important in advancing their care; however, traditional extubation criteria using the rapid shallow breathing index and negative inspiratory force do not predict success in these patients as well as they do in other intubated patients. This study aimed to evaluate these criteria in patients with spontaneous intracerebral haemorrhage to improve the extubation success rate. Methods We conducted a retrospective chart review of patients with spontaneous intracerebral haemorrhage (sICH) who underwent spontaneous breathing trials from 2018 to 2020. Twenty-nine patients met the inclusion criteria, and of these 29, 20 had a trial of extubation. Rapid shallow breathing index (RSBI), negative inspiratory force (NIF), and cuff leak were recorded to analyze breathing parameters at the time of extubation. Patients who required reintubation were noted. Results All trials of extubation required a cuff leak. Using RSBI, patients with values <105 or <85, as the only other extubation criteria, were associated with a 70.6% and 71.4% success rate, respectively. With RSBI <105 and NIF <-25 cm water, the success rate was 88.9%. Any patient with a cuff leak that had a NIF <-30 had a success rate of 100%, regardless of RSBI. Conclusion The RSBI was not a reliable isolated measure to predict 100% extubation success. Using a NIF <-30 predicts a 100% extubation success rate if a cuff leak is present. This demonstrates that the NIF may be a more useful metric in sICH patients, as it accounts for patient participation and innate ability to draw a breath spontaneously. Future studies are warranted to evaluate further and optimize the extubation criteria in these patients.
自发性脑出血患者具有较高的发病率和死亡率。对他们的护理包括机械通气的需求。安全有效地为患者撤机对于推进其治疗很重要；然而，使用快速浅呼吸指数和吸气负压的传统撤机标准在预测这些患者撤机成功方面，不如在其他插管患者中那样准确。本研究旨在评估这些标准在自发性脑出血患者中的应用，以提高撤机成功率。方法：我们对2018年至2020年接受自主呼吸试验的自发性脑出血（sICH）患者进行了回顾性病历审查。29名患者符合纳入标准，其中20名进行了撤机试验。记录快速浅呼吸指数（RSBI）、吸气负压（NIF）和套囊漏气情况，以分析撤机时的呼吸参数。记录需要再次插管的患者。结果：所有撤机试验均需要套囊漏气。将RSBI值<105或<85作为唯一的其他撤机标准时患者的成功率分别为70.6%和71.4%。当RSBI<105且NIF<-25 cm水柱时，成功率为88.9%。任何存在套囊漏气且NIF<-30的患者，无论RSBI如何，成功率均为100%。结论：RSBI并非预测100%撤机成功的可靠单一指标。如果存在套囊漏气，使用NIF<-30可预测100%的撤机成功率。这表明NIF在sICH患者中可能是一个更有用的指标指标，因为它考虑了患者的参与度和自主吸气的内在能力。有必要进行进一步研究以评估并优化这些患者的撤机标准。
