Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Apr 1;84(4):368-374. doi: 10.1097/JCMA.0000000000000509.
Delayed extubation is one of postoperative pulmonary complications (PPCs). Preoperative pulmonary function test (PFT) is an important assessment for patients undergoing lung resection. Volume-oriented incentive spirometry (IS) is one of physiotherapies to prevent PPCs. Preoperative PFT and IS volume (IS-v) can reflect the physiologic conditions of respiratory system in patients planning to undergo lung resection. However, the relationship between preoperative PFT/IS-v and delayed extubation in patients undergoing lung resection remains unclear. The study investigated the risk factors and impact of delayed extubation after lung resection. We aimed to achieve early recognition of patients being at a higher risk for developing postoperative delayed extubation after lung resection.
This retrospective observational 4-year cohort study was conducted in a medical center, Taiwan. A total of 353 enrolled patients receiving thoracic surgery for lung resection were further categorized into the delayed extubation (n = 142, 40%) and non-delayed extubation (n = 211, 60%) groups.
In multivariate logistic regression analyses, age >65 years (adjusted odds ratio [AOR]: 2.60; 95% confidence interval [CI], 1.52-4.45), American Society of Anesthesiologists score >2 (AOR: 1.72; 95% CI, 1.05-2.82), anesthesia time >6hrs (AOR: 1.80; 95% CI, 1.13-2.88), pneumonectomy (AOR: 5.58; 95% CI, 1.62-19.19), and IS-v/inspiratory capacity (IC) ratio (AOR: 2.07; 95% CI, 1.16-3.68) were associated with delayed extubation after lung resection (all p < 0.05). Patients with delayed extubation were significantly associated with a higher proportion of other pulmonary complications, reintubation, mortality, and prolonged intensive care unit and hospital stays.
Older age, poor general health status, longer anesthesia time, pneumonectomy, and IS-v/IC ratio could be the independent factors predictive for delayed extubation after lung resection, which was in turn associated with worse outcomes. Preoperative PFT and IS-v were valuable for early recognition of patients being at a higher risk for developing postoperative delayed extubation after lung resection.
延迟拔管是术后肺部并发症（PPC）之一。术前肺功能检查（PFT）是评估接受肺切除术患者的重要评估手段。以容量为导向的激励式呼吸训练（IS）是预防 PPC 的一种物理疗法。术前 PFT 和 IS 容量（IS-v）可以反映计划接受肺切除术患者的呼吸系统生理状况。然而，肺切除术患者术前 PFT/IS-v 与延迟拔管之间的关系尚不清楚。本研究调查了肺切除术后延迟拔管的危险因素和影响。我们旨在早期识别肺切除术后发生术后延迟拔管风险较高的患者。
这是一项在台湾一家医疗中心进行的回顾性观察性 4 年队列研究。共纳入 353 名接受胸外科肺切除术的患者，进一步分为延迟拔管（n=142，40%）和非延迟拔管（n=211，60%）两组。
多变量逻辑回归分析显示，年龄>65 岁（调整优势比 [AOR]：2.60；95%置信区间 [CI]：1.52-4.45）、美国麻醉医师协会评分>2（AOR：1.72；95%CI：1.05-2.82）、麻醉时间>6 小时（AOR：1.80；95%CI：1.13-2.88）、全肺切除术（AOR：5.58；95%CI：1.62-19.19）和 IS-v/IC 比值（AOR：2.07；95%CI：1.16-3.68）与肺切除术后延迟拔管相关（均 p<0.05）。延迟拔管的患者与其他肺部并发症、再次插管、死亡率以及重症监护病房和住院时间延长的比例显著相关。
年龄较大、一般健康状况较差、麻醉时间较长、全肺切除术和 IS-v/IC 比值是肺切除术后延迟拔管的独立预测因素，而延迟拔管与更差的预后相关。术前 PFT 和 IS-v 有助于早期识别肺切除术后发生术后延迟拔管风险较高的患者。
