肥胖患者重症监护病房拔管失败的发生率、危险因素及长期预后：一项多中心前瞻性观察研究的回顾性分析

Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity: A Retrospective Analysis of a Multicenter Prospective Observational Study.

作者信息

De Jong Audrey, Capdevila Mathieu, Aarab Yassir, Cros Matthieu, Pensier Joris, Lakbar Ines, Monet Clément, Quintard Hervé, Cinotti Raphael, Asehnoune Karim, Arnal Jean-Michel, Guitton Christophe, Paugam-Burtz Catherine, Abback Paer, Mekontso-Dessap Armand, Lakhal Karim, Lasocki Sigismond, Plantefeve Gaetan, Claud Bernard, Pottecher Julien, Corne Philippe, Ichai Carole, Molinari Nicolas, Chanques Gerald, Papazian Laurent, Azoulay Elie, Jaber Samir

机构信息

Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, and Centre Hospitalier Universitaire Montpellier, Montpellier, France.

Division of Intensive Care, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

出版信息

Chest. 2025 Jan;167(1):139-151. doi: 10.1016/j.chest.2024.07.171. Epub 2024 Sep 7.

DOI:10.1016/j.chest.2024.07.171

PMID:39182573

Abstract

BACKGROUND

To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.

RESEARCH QUESTION

What are the incidence and risk factors of extubation failure in patients with and without obesity?

STUDY DESIGN AND METHODS

In the prospective multicenter observational Practices and Risk Factors for Weaning and Extubation Airway Failure in Adult Intensive Care Unit: A Multicenter Trial (FREEREA) study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure using first a logistic regression model and second a decision tree analysis.

RESULTS

Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.

INTERPRETATION

Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rates of extubation failure among patients with and without obesity.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT02450669; URL: www.

CLINICALTRIALS

gov.

摘要

背景

据我们所知，尚无大型观察性研究对未选择的有肥胖和无肥胖的危重症患者同一队列中48小时内及重症监护病房（ICU）住院期间拔管失败的发生率和危险因素进行比较。

研究问题

有肥胖和无肥胖患者拔管失败的发生率及危险因素是什么？

研究设计与方法

在一项于26个ICU进行的前瞻性多中心观察性研究“成人重症监护病房撤机和拔管气道失败的实践与危险因素：一项多中心试验（FREEREA）”中，主要目标是比较有肥胖和无肥胖患者48小时内拔管失败的发生率。次要目标是首先使用逻辑回归模型，其次使用决策树分析来描述并确定拔管失败的独立特定危险因素。

结果

在分析的1370例拔管操作中，288例（21%）在肥胖患者中进行，1082例（79%）在无肥胖患者中进行。有肥胖和无肥胖患者48小时内拔管失败的发生率分别为288例中的23例（8.0%）和1082例中的118例（11%）（未调整的比值比，0.71；95%置信区间，0.45 - 1.13；P = 0.15）；此外，肥胖患者接受无创通气的比例显著高于无肥胖患者[288例中的87例（30%）对1082例中的233例（22%）；P = 0.002]以及接受物理治疗的比例也更高[288例中的165例（57%）对1082例中的527例（49%）；P = 0.02]。拔管失败的危险因素也因肥胖状态而异：肥胖患者中女性（调整后的比值比，4.88；95%置信区间，1.61 - 13.9；P = 0.002）和拔管前躁动（调整后的比值比，6.39；95%置信区间，1.91 - 19.8；P = 0.001），无肥胖患者中拔管前无强烈咳嗽（调整后的比值比，2.38；95%置信区间，1.53 - 3.84；P = 0.0002）以及拔管前有创机械通气时间（调整后的比值比，1.03/天；95%置信区间，1.01 - 1.06；P = 0.01）。决策树分析发现了类似的危险因素。