影響非計畫性拔除氣管內管後成功脫離氣管內管及呼吸器病人之探討

Effects Successful Patient Discharged with Endotracheal Tube and Mechanical Ventilation after Unplanned Extubation

歐羽珊(Yu-Shan Ou) ； 林怡君(I-chun Lin) ； 林秀燕(Hsin-Yam Lin) ； 楊燦(Tsan Yang)

《中華職業醫學雜誌》 20卷2期 (2013/04) Pp. 109-118

摘要

Objectives: The purpose of this research is to locate the related factors that affect the success of unplanned endotracheal tube extubation (UEE) in individual properties and medical care process. Methods: Research subjects were UEE patients from an adult intensive care unit at a teaching hospital in Southern Taiwan. A retrospective study was adopted and data were collected by reviewing literature and case histories. Descriptive statistics and difference analysis were conducted for various statistical analysis. Results: Among 134 UEE cases, the majority were males (73.9%), aged 60 or above (78.4%), and medical patients (80.6%). The primary cause of respiratory failure was pneumonia (47%). The average severity of disease on the APACHE II scale was 19.01%. The average time between intubation and extubation was 141.87 hours, and the time between intubation and extubation of 65.7% patients was over 48 hours. A total of 33.1% patients entered the mechanical ventilation weaning protocol with most removed independently (88.8%). The time between re-intubation and UEE less than 24 hours was 69.4%. In terms of ICU discharge, most patients transferred to general wards (68.7%). Among 134 UEE cases, 88 were successful. Patients under 60 years of age, surgical patients, entered the mechanical ventilation weaning protocol, and had better oxygenation concentration that reached a significant difference with the success or failure of UEE (p ＜ 0.05). Conclusions: The prediction of success for UEE is an important care guidance for patients using mechanical ventilators. Endotracheal intubation is an invasive procedure that tends to cause discomfort. The condition of patients must be evaluated in clinical practice to find a suitable time for extubation and a channel for removal of endotracheal tubes earlier.

關鍵字

加護病房 ； 非計畫性拔除氣管內管 ； 非計畫性拔除氣管內管成功

並列摘要

Objectives: The purpose of this research is to locate the related factors that affect the success of unplanned endotracheal tube extubation (UEE) in individual properties and medical care process. Methods: Research subjects were UEE patients from an adult intensive care unit at a teaching hospital in Southern Taiwan. A retrospective study was adopted and data were collected by reviewing literature and case histories. Descriptive statistics and difference analysis were conducted for various statistical analysis. Results: Among 134 UEE cases, the majority were males (73.9%), aged 60 or above (78.4%), and medical patients (80.6%). The primary cause of respiratory failure was pneumonia (47%). The average severity of disease on the APACHE II scale was 19.01%. The average time between intubation and extubation was 141.87 hours, and the time between intubation and extubation of 65.7% patients was over 48 hours. A total of 33.1% patients entered the mechanical ventilation weaning protocol with most removed independently (88.8%). The time between re-intubation and UEE less than 24 hours was 69.4%. In terms of ICU discharge, most patients transferred to general wards (68.7%). Among 134 UEE cases, 88 were successful. Patients under 60 years of age, surgical patients, entered the mechanical ventilation weaning protocol, and had better oxygenation concentration that reached a significant difference with the success or failure of UEE (p ＜ 0.05). Conclusions: The prediction of success for UEE is an important care guidance for patients using mechanical ventilators. Endotracheal intubation is an invasive procedure that tends to cause discomfort. The condition of patients must be evaluated in clinical practice to find a suitable time for extubation and a channel for removal of endotracheal tubes earlier.

並列關鍵字

intensive care unit ； unplanned endotracheal tube extubation ； success of unplanned endotracheal tube extubation