Kumari Nisha, Kumari Bibha, Kumar Sanjeev, Arun Nidhi, Kumari Ritu
Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Department of Emergency Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Indian J Anaesth. 2024 Mar;68(3):246-253. doi: 10.4103/ija.ija_620_23. Epub 2024 Feb 22.
The incidence of tracheal extubation failure in high-risk patients is higher, and non-invasive ventilation is suggested to avoid tracheal reintubation. This study compares the effectiveness of bilevel positive airway pressure (BiPAP) and high flow nasal cannula (HFNC) to reduce the rate of reintubation in intensive care unit (ICU) patients with increased risk of extubation failure.
This randomised comparative trial was conducted on 60 high-risk patients on mechanical ventilators admitted to the ICU, ready for weaning after a spontaneous breathing trial. They were randomised to Group H for HFNC and Group B for BiPAP therapy. Designated therapy was administered in these high-risk patients for up to 48 hours after tracheal extubation. Haemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), a saturation of peripheral oxygen (SpO), electrocardiogram (ECG)], arterial blood gas analysis (ABG) parameter [potential of hydrogen (pH), partial pressure of carbon dioxide (pCO), partial pressure of oxygen/fraction of inspired oxygen (paO/FiO) ratio], the effectiveness of cough, comfort level was recorded and continuous monitoring for signs of respiratory distress and failure was done.
Most of the patients were obese and had more than two risk factors for extubation failure. Several patients in Group B have significantly higher successful extubation than in Group H ( = 0.044). Most of the reintubation took place within 24 hours. The HFNC therapy was more comfortable and acceptable to patients.
BiPAP therapy was more efficient than HFNC in preventing tracheal reintubation among patients with a high risk of extubation failure.
高危患者气管拔管失败的发生率较高，建议采用无创通气以避免再次气管插管。本研究比较双水平气道正压通气（BiPAP）和高流量鼻导管吸氧（HFNC）在降低重症监护病房（ICU）中拔管失败风险增加的患者再次插管率方面的有效性。
本随机对照试验对60例入住ICU且使用机械通气、准备在自主呼吸试验后撤机的高危患者进行。将他们随机分为接受HFNC治疗的H组和接受BiPAP治疗的B组。在这些高危患者气管拔管后给予指定治疗长达48小时。记录血流动力学参数[平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、外周血氧饱和度（SpO）、心电图（ECG）]、动脉血气分析（ABG）参数[酸碱度（pH）、二氧化碳分压（pCO）、氧分压/吸入氧分数（paO/FiO）比值]、咳嗽有效性、舒适度，并持续监测呼吸窘迫和衰竭迹象。
大多数患者肥胖，且有两个以上拔管失败的危险因素。B组的成功拔管患者显著多于H组（P = 0.044）。大多数再次插管发生在24小时内。HFNC治疗让患者感觉更舒适且更容易接受。
在拔管失败风险高的患者中，BiPAP治疗在预防气管再次插管方面比HFNC更有效。
