Departamento de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil.
Departamento de Terapia Intensiva, Hospital de Clínicas de Poto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil.
Rev Bras Ter Intensiva. 2021 Oct 25;33(3):422-427. doi: 10.5935/0103-507X.20210057. eCollection 2021.
To assess whether there is an association between 48-hour postextubation fluid balance and extubation failure.
This was a prospective cohort study that included patients admitted to the intensive care unit of a tertiary hospital in southern Brazil from March 2019 to December 2019. Patients who required mechanical ventilation for at least 24 hours and who were extubated during the study period were included. The primary outcome was extubation failure, considered as the need for reintubation in the first 72 hours after extubation. The secondary outcome was a combined outcome with extubation failure or the need for therapeutic noninvasive ventilation.
A total of 101 patients were included. Extubation failure was observed in 29 (28.7%) patients. In univariate analysis, patients with a negative 48-hour postextubation fluid balance higher than one liter had a lower rate of extubation failure (12.0%) than patients with a negative 48-hour postextubation fluid balance lower than 1L (34.2%; p = 0.033). Mechanical ventilation duration and negative 48-hour postextubation fluid balance lower than one liter were associated with extubation failure when corrected for Simplified Acute Physiology Score 3 in multivariate analysis. When we evaluated the combined outcome, only negative 48-hour postextubation lower than 1L maintained an association when corrected for for Simplified Acute Physiology Score 3 and mechanical ventilation duration.
The 48-hour postextubation fluid balance is associated with extubation failure. Further studies are necessary to assess whether avoiding positive fluid balance in this period might improve weaning outcomes.
评估拔管后 48 小时内的液体平衡与拔管失败之间是否存在关联。
这是一项前瞻性队列研究，纳入了 2019 年 3 月至 2019 年 12 月期间在巴西南部一家三级医院重症监护病房住院的患者。纳入标准为需要机械通气至少 24 小时且在研究期间拔管的患者。主要结局为拔管失败，定义为拔管后 72 小时内需要再次插管。次要结局为拔管失败或需要治疗性无创通气的联合结局。
共纳入 101 例患者。29 例（28.7%）患者发生拔管失败。单因素分析显示，拔管后 48 小时内液体平衡呈负性且大于 1L 的患者，其拔管失败率（12.0%）低于液体平衡呈负性且小于 1L 的患者（34.2%；p=0.033）。多因素分析校正简化急性生理学评分 3 后，机械通气时间和拔管后 48 小时内液体平衡呈负性且小于 1L 与拔管失败相关。当我们评估联合结局时，只有拔管后 48 小时内液体平衡呈负性且小于 1L 在校正简化急性生理学评分 3 和机械通气时间后仍与结局相关。
拔管后 48 小时内的液体平衡与拔管失败相关。需要进一步研究评估在此期间避免正性液体平衡是否可以改善脱机结局。
