Al-Ali Aqeel Hamad, Alraeyes Khalid Abdullah, Julkarnain Princess Rhea, Lakshmanan Arul Prasath, Alobaid Alzahra, Aljoni Ahmed Yahya, Saleem Nada Hadi, Al Odat Mohammed Ali, Aletreby Waleed Tharwat
Respiratory Care Administration, King Saud Medical City, Riyadh, Saudi Arabia.
Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
Saudi J Med Med Sci. 2024 Jul-Sep;12(3):216-222. doi: 10.4103/sjmms.sjmms_19_24. Epub 2024 Jun 20.
Mechanical ventilation provides essential support for critically ill patients in several diagnoses; however, extubation failure can affect patient outcomes. From Saudi Arabia, no study has assessed the factors associated with extubation failure in adults.
This prospective observational study was conducted in the intensive care unit of a tertiary care hospital in Riyadh, Saudi Arabia. Adult patients who had been mechanically ventilated via the endotracheal tube for a minimum of 24 hours and then extubated according to the weaning protocol were included. Failed extubation was defined as reintubation within 48 hours of extubation.
A total of 505 patients were included, of which 72 patients had failed extubation (14.3%, 95% CI: 11.4%-17.7%). Compared with the failed extubation group, the successfully extubated group had significantly shorter duration of mechanical ventilation (mean difference: -2.6 days, 95% CI: -4.3 to -1; = 0.001), a slower respiratory rate at the time of extubation (mean difference: -2.3 breath/min, 95% CI: -3.8 to -1; = 0.0005), higher pH (mean difference: 0.02, 95% CI: 0.001-0.04; = 0.03), and more patients with strong cough (percent difference: 17.7%, 95% CI: 4.8%-30.5%; = 0.02). Independent risk factors of failed extubation were age (aOR = 1.02; 95% CI: 1.002-1.03; = 0.03), respiratory rate (aOR = 1.06, 95% CI: 1.01-1.1; = 0.008), duration of mechanical ventilation (aOR = 1.08, 95% CI: 1.03 - 1.1; < 0.001), and pH (aOR = 0.02, 95% CI: 0.0006-0.5; = 0.02).
Older age, longer duration of mechanical ventilation, faster respiratory rate, and lower pH were found to be independent risk factors that significantly increased the odds of extubation failure among adults.
机械通气为多种诊断的重症患者提供重要支持；然而，拔管失败会影响患者预后。沙特阿拉伯尚无研究评估成人拔管失败的相关因素。
本前瞻性观察性研究在沙特阿拉伯利雅得一家三级医院的重症监护病房进行。纳入经气管插管机械通气至少24小时后根据撤机方案进行拔管的成年患者。拔管失败定义为拔管后48小时内再次插管。
共纳入505例患者，其中72例拔管失败（14.3%，95%可信区间：11.4%-17.7%）。与拔管失败组相比，成功拔管组机械通气时间显著缩短（平均差值：-2.6天，95%可信区间：-4.3至-1；P = 0.001），拔管时呼吸频率较慢（平均差值：-2.3次/分钟，95%可信区间：-3.8至-1；P = 0.0005），pH值较高（平均差值：0.02，95%可信区间：0.001-0.04；P = 0.03），且咳嗽有力的患者更多（百分比差值：17.7%，95%可信区间：4.8%-30.5%；P = 0.02）。拔管失败的独立危险因素为年龄（校正比值比=1.02；95%可信区间：1.002-1.03；P = 0.03）、呼吸频率（校正比值比=1.06，95%可信区间：1.01-1.1；P = 0.008）、机械通气时间（校正比值比=1.08，95%可信区间：1.03-1.1；P<0.001）和pH值（校正比值比=0.02，95%可信区间：0.0006-0.5；P = 0.02）。
年龄较大、机械通气时间较长、呼吸频率较快和pH值较低是成人拔管失败几率显著增加的独立危险因素。
