計劃性拔管與非計劃性拔管病人之預後

The Prognosis of Planned Extubation and Unplanned Extubation Patients

許重梅(Chun-Mei Hsu) ； 張炎德(Yen-Teh Chang) ； 魏美觀(Mei-Guan Wei) ； 李寶琳(Pao-Lin Lee) ； 林英芬(Ying-Fen Lin) ； 林惠釧(Hui-Chuan Lin)

《呼吸治療》 12卷2期 (2013/07) Pp. 17-27

https://doi.org/10.6269/JRT.2013.12.2.02

摘要

Aim: Unplanned endotracheal tube extubation (UEE) is an important index for medical quality in critical care. However, UEE is not predicting medical process, and not lower population. Therefore, this issue is worthily study in the outcomes and related effect of ventilator patients. This study have compared with clinical characters, extubation status and the prognosis of planned and extubation and unplanned extubation patients. Method: The study was processed in an 875-bed local teaching hospital in northern of Taiwan. The patients were admission between 2008/1/1~2009/12/31 for major operation or critical care, older than 18 years old, and respiratory failure with ventilator support. From five adult ICU, total 133 UEE patients and 200 planned endotracheal tube extubation patients were selected for statistic analysis. Result: About characteristics of patients, UEE patients had higher Glasgow coma scale (8.96±1.25 vs 8.33±1.46, P＜0.0001) and lower APACHE II (22.59±9.53 vs 27.93±17.91, P=0.0006) than planned endotracheal tube extubation patients. About extubation status among weaning training, still 53.3% UEE during weaning training patients still need re-intubation and the time from extubation to re-intubation was shorter than planned endotracheal tube extubation patients (P＜0.0001). About prognosis, the percentage need re-intubation was higher among UEE patients (P＜0.0001) and 89*% weaning failure cases need re-intubation within 12 hours. The mortality of UEE patients was higher than planned endotracheal tube extubation patients (P = 0.0027). Higher mortality (P = 0.0282), longer ventilator days (P＜0.0001) and long ICU days (P=0.0016) was found among weaning failure than weaning successful cases. Conclusion: It was found that UEE patients were susceptible for non-spontaneous mode, FiO2 around 45%, Glasgow coma scale 8.96 and APACHE II 22.5. Still 53.3% UEE during weaning training patients need re-intubation. UEE patients had higher re-intubation rate and mortality. Weaning failure cases had higher mortality, longer ventilator days and long ICU days. Therefore, some aggressive intervention should be made to prevent UEE in ventilator patients.

關鍵字

非計劃性拔除氣管內管 ； 格拉斯哥氏昏迷量表 ； 疾病嚴重度

並列摘要

Aim: Unplanned endotracheal tube extubation (UEE) is an important index for medical quality in critical care. However, UEE is not predicting medical process, and not lower population. Therefore, this issue is worthily study in the outcomes and related effect of ventilator patients. This study have compared with clinical characters, extubation status and the prognosis of planned and extubation and unplanned extubation patients. Method: The study was processed in an 875-bed local teaching hospital in northern of Taiwan. The patients were admission between 2008/1/1~2009/12/31 for major operation or critical care, older than 18 years old, and respiratory failure with ventilator support. From five adult ICU, total 133 UEE patients and 200 planned endotracheal tube extubation patients were selected for statistic analysis. Result: About characteristics of patients, UEE patients had higher Glasgow coma scale (8.96±1.25 vs 8.33±1.46, P＜0.0001) and lower APACHE II (22.59±9.53 vs 27.93±17.91, P=0.0006) than planned endotracheal tube extubation patients. About extubation status among weaning training, still 53.3% UEE during weaning training patients still need re-intubation and the time from extubation to re-intubation was shorter than planned endotracheal tube extubation patients (P＜0.0001). About prognosis, the percentage need re-intubation was higher among UEE patients (P＜0.0001) and 89*% weaning failure cases need re-intubation within 12 hours. The mortality of UEE patients was higher than planned endotracheal tube extubation patients (P = 0.0027). Higher mortality (P = 0.0282), longer ventilator days (P＜0.0001) and long ICU days (P=0.0016) was found among weaning failure than weaning successful cases. Conclusion: It was found that UEE patients were susceptible for non-spontaneous mode, FiO2 around 45%, Glasgow coma scale 8.96 and APACHE II 22.5. Still 53.3% UEE during weaning training patients need re-intubation. UEE patients had higher re-intubation rate and mortality. Weaning failure cases had higher mortality, longer ventilator days and long ICU days. Therefore, some aggressive intervention should be made to prevent UEE in ventilator patients.

並列關鍵字

unplanned endotracheal tube extubation(UEE) ； Glasgow coma scale(GCS) ； APACHE Ⅱ