Liu Wanglin, Chi Yi, Zhao Yutong, He Huaiwu, Long Yun, Zhao Zhanqi
State Key Laboratory of Complex Severe and Rare Disease, Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
Department of Critical Care Medicine, The First Clinical Medical College of Shanxi Medical University, Taiyuan, China.
J Intensive Care. 2024 Jun 24;12(1):23. doi: 10.1186/s40560-024-00737-z.
Difficult-to-wean patients, typically identified as those failing the initial spontaneous breathing trial (SBT), face elevated mortality rates. Pendelluft, frequently observed in patients experiencing SBT failure, can be conveniently detected through bedside monitoring with electrical impedance tomography (EIT). This study aimed to explore the impact of pendelluft during SBT on difficult-to-wean patients.
This retrospective observational study included difficult-to-wean patients undergoing spontaneous T piece breathing, during which EIT data were collected. Pendelluft occurrence was defined when its amplitude exceeded 2.5% of global tidal impedance variation. Physiological parameters during SBT were retrospectively retrieved from the EIT Examination Report Form. Other clinical data including mechanical ventilation duration, length of ICU stay, length of hospital stay, and 28-day mortality were retrieved from patient records in the hospital information system for each subject.
Pendelluft was observed in 72 (70.4%) of the 108 included patients, with 16 (14.8%) experiencing mortality by day 28. The pendelluft group exhibited significantly higher mortality (19.7% vs. 3.1%, p = 0.035), longer median mechanical ventilation duration [9 (5-15) vs. 7 (5-11) days, p = 0.041] and shorter ventilator-free days at day 28 [18 (4-22) vs. 20 (16-23) days, p = 0.043]. The presence of pendellfut was independently associated with increased mortality at day 28 (OR = 10.50, 95% confidence interval 1.21-90.99, p = 0.033).
Pendelluft occurred in 70.4% of difficult-to-wean patients undergoing T piece spontaneous breathing. Pendelluft was associated with worse clinical outcomes, including prolonged mechanical ventilation and increased mortality in this population. Our findings underscore the significance of monitoring pendelluft using EIT during SBT for difficult-to-wean patients.
撤机困难的患者，通常指那些初次自主呼吸试验（SBT）失败的患者，面临着更高的死亡率。在经历SBT失败的患者中经常观察到肺内气体摆动，通过床边电阻抗断层成像（EIT）监测可以方便地检测到。本研究旨在探讨SBT期间肺内气体摆动对撤机困难患者的影响。
这项回顾性观察性研究纳入了接受T管自主呼吸的撤机困难患者，在此期间收集EIT数据。当肺内气体摆动幅度超过全球潮气量阻抗变化的2.5%时，定义为发生肺内气体摆动。SBT期间的生理参数从EIT检查报告表中进行回顾性提取。其他临床数据，包括机械通气时间、重症监护病房（ICU）住院时间、住院时间和28天死亡率，从医院信息系统中每个受试者的患者记录中提取。
108例纳入患者中有72例（70.4%）观察到肺内气体摆动，其中16例（14.8%）在28天内死亡。肺内气体摆动组的死亡率显著更高（19.7%对3.1%，p = 0.035），机械通气中位时间更长[9（5 - 15）天对7（5 - 11）天，p = 0.041]，28天时无呼吸机天数更短[18（4 - 22）天对20（16 - 23）天，p = 0.043]。肺内气体摆动的存在与28天死亡率增加独立相关（比值比=10.50，95%置信区间1.21 - 90.99，p = 0.033）。
在接受T管自主呼吸的撤机困难患者中，70.4%发生了肺内气体摆动。肺内气体摆动与更差的临床结局相关，包括该人群机械通气时间延长和死亡率增加。我们的研究结果强调了在SBT期间使用EIT监测撤机困难患者肺内气体摆动的重要性。
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