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[烧伤患者拔管失败:发生率、危险因素及预后]

[EXTUBATION FAILURE IN BURNS: INCIDENCE, RISK FACTORS AND PROGNOSIS].

作者信息

Cheikhrouhou M, Fredj H, Mokline A, Ben Saad M, Gasri B, Jami I, Messadi A-A

机构信息

Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie.

Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunisie.

出版信息

Ann Burns Fire Disasters. 2024 Jun 30;37(2):112-117. eCollection 2024 Jun.

Abstract

The incidence of extubation failure varies between 2 and 25% depending on the studied population. Few studies have been conducted in burn victims. To determine the incidence, causes, risk factors and outcome of burned patients after a failed extubation, a retrospective single-center case-control study was conducted over a period of 3 years (January 2018-December 2021). All burned patients aged over 16, ventilated for at least 24 hours and having had at least one extubation attempt were included. Extubation failure was defined as the need for re-intubation within 48 hours. Eighty-eight patients had planned extubation. These patients were divided into 2 groups comparable in terms of age and sex. Failure group: including patients with failed extubation (N= 34) and a success group (N= 64) including patients who succeeded. The incidence of extubation failure was 36.6%. Hypophosphatemia, anemia <8g/dl, duration of mechanical ventilation of 8,5 days and abundant secretions during extubation were identified as risk factors for extubation failure (p<0.05). The main cause of failure was retention of secretion (50%). Extubation failure was associated with prolonged length of stay (34 vs. 19 days, P= 0.005), increased infectious complications (P=0.007) and mortality rate (79.4%, 1.5%, P<0.001).

摘要

拔管失败的发生率在2%至25%之间,具体取决于所研究的人群。针对烧伤患者进行的研究较少。为了确定烧伤患者拔管失败后的发生率、原因、风险因素及预后,我们进行了一项为期3年(2018年1月至2021年12月)的回顾性单中心病例对照研究。纳入所有年龄超过16岁、机械通气至少24小时且至少有一次拔管尝试的烧伤患者。拔管失败定义为在48小时内需要再次插管。88例患者计划进行拔管。这些患者按年龄和性别分为两组。失败组:包括拔管失败的患者(N = 34);成功组(N = 64)包括拔管成功的患者。拔管失败的发生率为36.6%。低磷血症、血红蛋白<8g/dl、机械通气时间8.5天以及拔管时分泌物过多被确定为拔管失败的风险因素(p<0.05)。失败的主要原因是分泌物潴留(50%)。拔管失败与住院时间延长(34天对19天,P = 0.005)、感染并发症增加(P = 0.007)和死亡率升高(79.4%对1.5%,P<0.001)相关。

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