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重症监护病房肥胖患者撤机失败的发生率

Incidence of Weaning Failure in Obese Patients in Intensive Care Unit.

作者信息

Ilyas Anum, Kharadi Nusrat, Shafique Mudassir, Mehreen Tooba, Habib Maria, Khan Jaffar, Akhtar Aftab, Kiran Fnu, Mehmood Farrukh

机构信息

Critical Care Department, Shifa International Hospital Islamabad, Islamabad, PAK.

Pulmonology Department, Islamabad Medical Complex, Islamabad, PAK.

出版信息

Cureus. 2024 Mar 10;16(3):e55881. doi: 10.7759/cureus.55881. eCollection 2024 Mar.

Abstract

Background The escalating prevalence of obesity worldwide presents unique challenges in critical care management, especially in the context of mechanical ventilation and weaning processes in intensive care units (ICUs). The present study aimed to determine the incidence of weaning failure in obese patients in an ICU. Methods A prospective observational study was carried out to gather data on patients in the ICU of Shifa International Hospital located in Islamabad, Pakistan. The target population consisted of adult patients who were both male and female, ages 18 years and above. These individuals required intubation procedures as well as mechanical ventilation during their hospitalization. The researchers followed these patients prospectively and observed their medical conditions closely to gather data about how obesity might impact critical care interventions and outcomes. Results The sample size was 288 bearing a median age of 61.0 with an interquartile range of 19 years. Older age manifested a significantly higher frequency of failed extubation (p=0.065). Higher body mass index (BMI) was significantly associated with failed extubation among the study population. It was found that a higher significant difference was associated with BMI > 30 kg/m (obese) in failed and successful extubation. One-half of the patients with failed extubation and only 16 (5.9%) patients with successful extubation had end-stage renal disease (p<0.001). It was found that patients who underwent failed extubation had notably increased ICU mortality (p=0.108), 28-day mortality (p=0.067), as well as mean ICU (p<0.001) and hospital stay (p=0.007). Conclusion Our study revealed some insightful correlations between obesity, age, comorbidities, length of hospitalization, ICU stay, and mortality rate in terms of weaning failure among the study population.

摘要

背景 全球肥胖患病率不断攀升,给重症监护管理带来了独特挑战,尤其是在重症监护病房(ICU)的机械通气和撤机过程中。本研究旨在确定ICU中肥胖患者撤机失败的发生率。方法 开展了一项前瞻性观察性研究,以收集位于巴基斯坦伊斯兰堡的法希尔国际医院ICU患者的数据。目标人群包括18岁及以上的成年男女患者。这些患者在住院期间需要进行插管及机械通气。研究人员对这些患者进行前瞻性跟踪,并密切观察他们的病情,以收集有关肥胖如何影响重症监护干预措施和结果的数据。结果 样本量为288例,中位年龄为61.0岁,四分位间距为19岁。年龄较大者拔管失败的频率显著更高(p = 0.065)。在研究人群中,较高的体重指数(BMI)与拔管失败显著相关。发现在拔管失败和成功的患者中,BMI > 30 kg/m²(肥胖)存在更高的显著差异。拔管失败的患者中有一半,而拔管成功的患者中只有16例(5.9%)患有终末期肾病(p < 0.001)。发现拔管失败的患者ICU死亡率(p = 0.108)、28天死亡率(p = 0.067)以及ICU平均住院时间(p < 0.001)和住院时间(p = 0.007)均显著增加。结论 我们的研究揭示了在研究人群中,肥胖、年龄、合并症、住院时间、ICU住院时间和死亡率在撤机失败方面存在一些有启发性的相关性。

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