计划拔管后48小时内再次插管对重症患者死亡率的影响。

Effect of Reintubation Within 48 Hours on Mortality in Critically Ill Patients After Planned Extubation.

作者信息

Dadam Michelli Marcela, Pereira Aline Braz, Cardoso Mariane Ribeiro, Carnin Tiago Costa, Westphal Glauco Adrieno

机构信息

The Hospital Municipal São José, Joinville, Santa Catarina, Brazil.

The Centro Hospitalar Unimed, Joinville, Santa Catarina, Brazil

出版信息

Respir Care. 2024 Jun 28;69(7):829-838. doi: 10.4187/respcare.11077.

DOI:10.4187/respcare.11077

PMID:38772683

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11285505/

Abstract

BACKGROUND

Re-intubation is necessary in 2% to 30% of cases of patients receiving a planned extubation. This procedure is associated with prolonged mechanical ventilation, a greater need for tracheostomy, a higher incidence of ventilator-associated pneumonia, and higher mortality. The aim of this study was to evaluate the effect of re-intubation within 48 h on mortality after planned extubation by using a randomized controlled trial database.

METHODS

Secondary analysis of a multi-center randomized trial, which evaluated the effect of reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial, followed by extubation. The study included adult subjects who received invasive mechanical ventilation for > 12 h. The subjects were divided into an extubation failure group and an extubation success group. The outcome was in-hospital mortality. Two multivariate logistic regression models were constructed to identify independent factors associated with mortality.

RESULTS

Among the 336 subjects studied, extubation failed in 52 (15.4%) and they were re-intubated within 48 h. Most re-intubations occurred between 12 and 24 h after planned extubation (median [interquartile range] 16 [6-36] h). Mortality of the extubation failure group was higher both in the ICU (32.6% vs 6.6%; odds ratio [OR] 6.77, 95% CI 3.22-14.24; < .001) and in-hospital (42.3% vs 14.0%; OR 4.47, 95% CI 2.34-8.51; < .001) versus the extubation success group. Multivariate logistic regression analyses showed that re-intubation within 48 h was independently associated with both ICU mortality (OR 6.10, 95% CI 2.84-13.07; < .001) and in-hospital mortality (OR 3.36, 95% CI 1.67-6.73; = .001). In-hospital mortality was also associated with rescue noninvasive ventilation after extubation (OR 2.44, 95% CI 1.25-4.75; = .009).

CONCLUSIONS

Re-intubation within 48 h after planned extubation was associated with mortality in subjects who were critically ill.

摘要

背景

在接受计划性拔管的患者中，2%至30%的病例需要再次插管。该操作与机械通气时间延长、气管切开需求增加、呼吸机相关性肺炎发病率升高及死亡率增加有关。本研究的目的是利用随机对照试验数据库评估48小时内再次插管对计划性拔管后死亡率的影响。

方法

对一项多中心随机试验进行二次分析，该试验评估了在成功的自主呼吸试验后重新连接机械通气1小时，然后进行拔管的效果。研究纳入接受有创机械通气超过12小时的成年受试者。受试者被分为拔管失败组和拔管成功组。结局指标为住院死亡率。构建两个多因素逻辑回归模型以确定与死亡率相关的独立因素。

结果

在研究的336名受试者中，52名（15.4%）拔管失败并在48小时内再次插管。大多数再次插管发生在计划性拔管后12至24小时（中位数[四分位间距]16[6 - 36]小时）。与拔管成功组相比，拔管失败组在重症监护病房（ICU）的死亡率更高（32.6%对6.6%；比值比[OR]6.77，95%置信区间3.22 - 14.24；P <.001），住院死亡率也更高（42.3%对14.0%；OR 4.47，95%置信区间2.34 - 8.51；P <.001）。多因素逻辑回归分析显示，48小时内再次插管与ICU死亡率（OR 6.10，95%置信区间2.84 - 13.07；P <.001）和住院死亡率（OR 3.36，95%置信区间1.67 - 6.73；P =.001）均独立相关。住院死亡率还与拔管后挽救性无创通气有关（OR 2.44，95%置信区间1.25 - 4.75；P =.009）。