Engidaw Meseret Sitotaw, Tekeba Berhan, Amare Hailu Tazebew, Belay Kalkidan Ambachew, Ayana Yezbalem, Liyew Bikis
Departement of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Sci Rep. 2025 Jul 1;15(1):20957. doi: 10.1038/s41598-025-05625-6.
Extubation failure occurs in mechanically ventilated patients after planned extubation. It can cause increased mortality, length of intensive care unit stays, prolonged mechanical ventilation use, increased hospital costs, and increased need for tracheostomy. In Ethiopia, extubation failure is limitedly studied among adult patients admitted to intensive care units. Therefore, this study aimed to assess the incidence and predictors of extubation failure among adult patients in intensive care units. A multicenter retrospective follow-up study was conducted among 380 extubated patients from mechanical ventilation at the intensive care unit in northwest Amhara comprehensive specialized hospitals from May 1, 2021, to April 30, 2024. The data was collected randomly from patient cards using a simple random method with a pretested checklist. The data was entered using Epi-Data 4.6 and analyzed using STATA 17. The Kaplan-Meier curve was used to estimate the median extubation failure time. The Cox proportional hazard regression model analyzes the relationship between independent and outcome variables. The overall incidence of extubation failure was 2.64 (95% CI: 1.97-3.54) per 1000 person-hour observations. Forty-five (12.33%) of participants had developed extubation failure. Comorbidities (AHR: 3.92, 95% CI: 1.41-10.81), prolonged mechanical ventilation duration (AHR: 4.69, 95% CI: 2.04-10.80), GCS ≤ 8 with tracheal intubation (AHR: 4.10, 95% CI: 2.10-7.97), and positive fluid balance (AHR: 2.39, 95% CI: 1.23-4.62) were independent predictors of extubation failure. Extubation failure among adult patients admitted to the intensive care unit was high in the first 24 h after extubation. The risk of extubation failure was higher for those patients with comorbidities, prolonged mechanical ventilation, GCS ≤ 8 with tracheal intubation, and positive fluid balance. Therefore, clinicians should prioritize patients who have comorbid conditions, require extended mechanical ventilation, have a Glasgow Coma Scale score of 8 or lower with tracheal intubation, or exhibit a positive fluid balance.
计划性拔管后，机械通气患者会发生拔管失败。这会导致死亡率增加、重症监护病房住院时间延长、机械通气使用时间延长、医院成本增加以及气管切开需求增加。在埃塞俄比亚，针对入住重症监护病房的成年患者，对拔管失败的研究有限。因此，本研究旨在评估重症监护病房成年患者拔管失败的发生率及预测因素。2021年5月1日至2024年4月30日期间，在阿姆哈拉西北部综合专科医院重症监护病房对380例机械通气后拔管的患者进行了一项多中心回顾性随访研究。使用简单随机方法，通过预先测试的检查表从患者病历中随机收集数据。数据使用Epi-Data 4.6录入，并使用STATA 17进行分析。采用Kaplan-Meier曲线估计拔管失败的中位时间。Cox比例风险回归模型分析自变量与结果变量之间的关系。每1000人时观察的拔管失败总体发生率为2.64（95%可信区间：1.97 - 3.54）。45名（12.33%）参与者出现了拔管失败。合并症（风险比：3.92，95%可信区间：1.41 - 10.81）、机械通气持续时间延长（风险比：4.69，95%可信区间：2.04 - 10.80）、气管插管时格拉斯哥昏迷量表（GCS）评分≤8（风险比：4.10，95%可信区间：2.10 - 7.97）以及液体正平衡（风险比：2.39，95%可信区间：1.23 - 4.62）是拔管失败的独立预测因素。入住重症监护病房的成年患者在拔管后的最初24小时内拔管失败率较高。合并症患者、机械通气时间延长患者、气管插管时GCS评分≤8的患者以及液体正平衡患者发生拔管失败的风险更高。因此，临床医生应优先关注合并症患者、需要长时间机械通气的患者、气管插管时格拉斯哥昏迷量表评分≤8的患者或出现液体正平衡的患者。
