is an assistant professor in the Department of Anesthesiology, at the University of Minnesota, Minneapolis, Minnesota.
Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota.
AANA J. 2021 Dec;89(6):476-479.
Among anesthesia-related life-threatening complications, respiratory failure requiring reintubation is common. However, studies evaluating patient characteristics for extubation failure are scarce in the literature. Such knowledge is important to increase awareness and for the development of strategies to improve the safety of anesthesia care. We retrospectively reviewed 196 cases that were reported to our quality assurance (QA) committee from 2004 to 2014 at 3 hospitals. The reintubation rate was 0.09% (n=196). More reintubations occurred in the operating room than the postanesthesia care unit (58% vs 30%). Ninety-three reintubated patients (47%) were 65 years or older. Most patients were in ASA class 3 or 4 (76%) and had a surgical procedure lasting longer than 3 hours. Eleven reintubated patients (5%) died during the hospital course. The exact causes of reintubation could not be determined because of limited data in our QA database. We conclude that although the individual risk of reintubation for each patient is low, the reintubated patients have a higher mortality rate. The study findings emphasize the need for extra vigilance before anesthesia providers attempt extubation of a patient who is elderly, underwent surgery over 3 hours, has chronic obstructive airway disease, or has ASA class 3 or 4 status.
在与麻醉相关的危及生命的并发症中，需要重新插管的呼吸衰竭较为常见。然而，在文献中评估拔管失败患者特征的研究很少。这种知识对于提高认识和制定提高麻醉护理安全性的策略非常重要。我们回顾了 2004 年至 2014 年在 3 家医院向我们的质量保证（QA）委员会报告的 196 例病例。重新插管的比率为 0.09%（n=196）。在手术室重新插管的次数多于麻醉后恢复室（58%对 30%）。93 例重新插管的患者（47%）年龄在 65 岁或以上。大多数患者为 ASA 3 级或 4 级（76%），手术时间超过 3 小时。11 例重新插管的患者（5%）在住院期间死亡。由于我们的 QA 数据库中的数据有限，无法确定重新插管的确切原因。我们得出结论，尽管每位患者重新插管的个体风险较低，但重新插管的患者死亡率较高。研究结果强调，在麻醉提供者试图为老年患者、手术时间超过 3 小时、患有慢性阻塞性气道疾病或 ASA 3 级或 4 级的患者拔管之前，需要格外警惕。
