Demling R H, Read T, Lind L J, Flanagan H L
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Crit Care Med. 1988 Jun;16(6):573-7. doi: 10.1097/00003246-198806000-00001.
The rate of extubation failure (reintubation rate) was determined for 700 consecutive extubations in surgical patients admitted to one of two ICUs. Patients were weaned in a standardized fashion and extubated using a standardized gas exchange and mechanics criteria. Of 400 extubations in the general surgical ICU, there were 22 reintubations in 20 patients. Average age was 65 yr, and the major reason for reintubation was need for positive-pressure ventilation. Morbidity (pulmonary edema and/or pneumonia) was 36%, and the inhospital mortality was 40% in this group. The major cause of death was progressive cardiopulmonary failure. There were 10 failures in eight patients, of 300 extubations in the Burn/Trauma unit, where the mean age was 44 yr. Five failures occurred in patients with smoke inhalation and burns, a 13% incidence in this population. The reason for reintubation was airway maintenance and pulmonary toilet. Four failures occurred in head injury patients, a 5% incidence with the major reason for reintubation being airway protection. Morbidity was 60% (new pulmonary infiltrates), while mortality rate was only 10% in this group. Only one failure was noted in a nonhead-injured trauma patient. In no group studied were any predictors of extubation failure detected. We conclude that the incidence, reasons for, and outcome of reintubations in surgical ICU patients varies dramatically depending on the underlying disease process. Overall failure rate was 4%.
在收治于两个重症监护病房（ICU）之一的外科手术患者中，对连续700例拔管病例确定了拔管失败率（再插管率）。患者以标准化方式进行撤机，并根据标准化的气体交换和力学标准进行拔管。在普通外科ICU的400例拔管病例中，20例患者出现了22次再插管。平均年龄为65岁，再插管的主要原因是需要正压通气。该组患者的发病率（肺水肿和/或肺炎）为36%，住院死亡率为40%。主要死亡原因是进行性心肺衰竭。在烧伤/创伤科的300例拔管病例中，8例患者出现了10次失败，平均年龄为44岁。5例失败发生在吸入烟雾和烧伤患者中，该人群的发生率为13%。再插管的原因是气道维持和肺部灌洗。4例失败发生在颅脑损伤患者中，发生率为5%，再插管的主要原因是气道保护。该组患者的发病率为60%（新的肺部浸润），而死亡率仅为10%。在非颅脑损伤的创伤患者中仅发现1例失败。在所研究的任何组中均未检测到拔管失败的预测因素。我们得出结论，外科ICU患者再插管的发生率、原因和结果因潜在疾病过程而异。总体失败率为4%。
