Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, P. R. China.
BMC Anesthesiol. 2024 Jul 10;24(1):232. doi: 10.1186/s12871-024-02603-9.
To report two-year survival after scheduled extubation in patients with pneumonia or acute respiratory distress syndrome (ARDS).
This was a prospective observational study performed in a respiratory ICU of a teaching hospital. Pneumonia or ARDS patients who successfully completed a spontaneous breathing trial were enrolled. Data were collected before extubation. Patients were followed up to two years by phone every 3 months.
A total of 230 patients were enrolled in final analysis. One-, 3-, 6-, 12-, and 24-month survival was 77.4%, 63.8%, 61.3%, 57.8%, and 47.8%, respectively. Cox regression shows that Charlson comorbidity index (hazard ratio: 1.20, 95% confidence interval: 1.10-1.32), APACHE II score before extubation (1.11, 1.05-1.17), cough peak flow before extubation (0.993, 0.986-0.999), and extubation failure (3.96, 2.51-6.24) were associated with two-year mortality. To predict death within two years, the area under the curve of receiver operating characteristic was 0.79 tested by Charlson comorbidity index, 0.75 tested by APACHE II score, and 0.75 tested by cough peak flow. Two-year survival was 31% and 77% in patients with Charlson comorbidity index ≥ 1 and < 1, 28% and 62% in patients with APACHE II score ≥ 12 and < 12, and 64% and 17% in patients with cough peak flow > 58 and ≤ 58 L/min, respectively.
Comorbidity, disease severity, weak cough and extubation failure were associated with increased two-year mortality in pneumonia or ARDS patients who experienced scheduled extubation. It provides objective information to caregivers to improve decision-making process during hospitalization and post discharge.
报告肺炎或急性呼吸窘迫综合征（ARDS）患者计划性拔管后的两年生存率。
这是一项在教学医院呼吸重症监护病房进行的前瞻性观察性研究。成功完成自主呼吸试验的肺炎或 ARDS 患者被纳入研究。在拔管前收集数据。通过电话每 3 个月对患者进行随访，随访时间长达两年。
共有 230 例患者纳入最终分析。1、3、6、12 和 24 个月的生存率分别为 77.4%、63.8%、61.3%、57.8%和 47.8%。Cox 回归显示，Charlson 合并症指数（风险比：1.20，95%置信区间：1.10-1.32）、拔管前的急性生理学与慢性健康状况评分系统 II 评分（1.11，1.05-1.17）、拔管前咳嗽峰流速（0.993，0.986-0.999）和拔管失败（3.96，2.51-6.24）与两年死亡率相关。通过 Charlson 合并症指数、急性生理学与慢性健康状况评分系统 II 评分和咳嗽峰流速评估，预测两年内死亡的受试者工作特征曲线下面积分别为 0.79、0.75 和 0.75。Charlson 合并症指数≥1 和<1 的患者两年生存率分别为 31%和 77%，急性生理学与慢性健康状况评分系统 II 评分≥12 和<12 的患者两年生存率分别为 28%和 62%，咳嗽峰流速>58 和≤58 L/min 的患者两年生存率分别为 64%和 17%。
在经历计划性拔管的肺炎或 ARDS 患者中，合并症、疾病严重程度、咳嗽无力和拔管失败与两年死亡率增加相关。这为护理人员提供了客观信息，以改善住院期间和出院后的决策过程。
