Non-Invasive Ventilation in the Management of Postextubation Respiratory Distress, a Retrospective Study

拔管後呼吸窘迫呼吸處置之回溯性研究

汪性寧(Hsing-Ning Wang) ； 葉育雯(Diana Y Yeh) ； 徐培菘(Pei-Sung Hsu) ； 賴君宇(Chun-Yu Lai) ； 江俊松(Jiunn-Song Jiang)

《呼吸治療》 13卷1期 (2014/01) Pp. 1-12

https://doi.org/10.6269/JRT.2014.13.1.01

摘要

Background and objective: Respiratory distress occurs frequently in patients after extubation and disconnection from mechanical ventilation. As long as it is not immediately life-threatening, physicians often have the choice of either a trial of noninvasive ventilation (NIV) or direct re-intubation. This retrospective study aimed to compare these two treatment options in managing post-extubation respiratory distress in terms of weaning outcome and survival.Methods: Patients with post-extubation respiratory distress in intensive care units (ICU) over a 2-year period were enrolled in the study retrospectively by chart review. A total of 131 patients who experienced respiratory distress after extubation were screened. Among them, 67 patients were placed on NIV when respiratory distress occurred post-extubation, while 64 patients were directly re-intubated. Parameters analyzed included time to intervention after post-extubation respiratory distress (Tinv), time to re-intubation (Treint) and cumulative ventilator-free days after extubation in a 28-day period (Temvf).Results: Patients with post-extubation distress who were placed on NIV had lower rate of re-intubation (p＜0.01), longer Temvf (p＜0.01), and higher probability of ventilator-independent survival at the end of 28 days. Using univariate analysis of variables for endotracheal mechanical ventilation free survival in 28 days, we found that NIV (p＜0.01) and re-intubation rate (p＜0.01) were significantly correlated with final outcomes of weaning. Further analysis with multivariate logistic regression found that reduced rate of re-intubation was most predictive of ventilator-free survival at the end of 28 days (OR: 7.74, p＜0.01).Conclusion: In our study, we demonstrated that early use of NIV in this situation can significantly reduce the rate of re-intubation and is associated with better weaning outcome and increased ventilator-independent survival.

關鍵字

非侵襲性呼吸器（Noninvasive Ventilator） ； 脫離（Weaning） ； 呼吸窘迫（Respiratory distress） ； 重插管（Re-intubation）

並列摘要

Background and objective: Respiratory distress occurs frequently in patients after extubation and disconnection from mechanical ventilation. As long as it is not immediately life-threatening, physicians often have the choice of either a trial of noninvasive ventilation (NIV) or direct re-intubation. This retrospective study aimed to compare these two treatment options in managing post-extubation respiratory distress in terms of weaning outcome and survival.Methods: Patients with post-extubation respiratory distress in intensive care units (ICU) over a 2-year period were enrolled in the study retrospectively by chart review. A total of 131 patients who experienced respiratory distress after extubation were screened. Among them, 67 patients were placed on NIV when respiratory distress occurred post-extubation, while 64 patients were directly re-intubated. Parameters analyzed included time to intervention after post-extubation respiratory distress (Tinv), time to re-intubation (Treint) and cumulative ventilator-free days after extubation in a 28-day period (Temvf).Results: Patients with post-extubation distress who were placed on NIV had lower rate of re-intubation (p＜0.01), longer Temvf (p＜0.01), and higher probability of ventilator-independent survival at the end of 28 days. Using univariate analysis of variables for endotracheal mechanical ventilation free survival in 28 days, we found that NIV (p＜0.01) and re-intubation rate (p＜0.01) were significantly correlated with final outcomes of weaning. Further analysis with multivariate logistic regression found that reduced rate of re-intubation was most predictive of ventilator-free survival at the end of 28 days (OR: 7.74, p＜0.01).Conclusion: In our study, we demonstrated that early use of NIV in this situation can significantly reduce the rate of re-intubation and is associated with better weaning outcome and increased ventilator-independent survival.

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