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Effect of Noninvasive Positive-Pressure Ventilation on Extubation Failure


背景和目的:探討面罩式“雙氣道正壓式呼吸器”對於T型管兩小時試驗,拔管失敗之影響。方法:選擇100位插管之呼吸器病患,當符合每日篩選指標(daily screen)時,接受2小時T型管自發性呼吸試驗,成功者給予拔除人工氣管插管,隨機使用氧氣面罩(O2 mask)或面罩式雙氣道正壓式呼吸器(NIV)。結果:100位呼吸器病患中有85位(85%)拔管成功,15位拔管失敗(15%),NIV組,拔管失敗率是18%(9/50位失敗);而O2 mask的群組是12%(6/50位失敗),在統計學上無顯著差異,15位拔管失敗患者有6位重插管,其中有2位死亡,可讓拔管失敗的病患之再插管率降至(6/15, 40%)。結論:通過T型管兩小時自發性呼吸測試之病患,拔管後預防性的使用非侵入性呼吸器無法有效降低拔管失敗率。

Parallel abstracts

Background and Purpose: Mechanical ventilation can save the life of a patient with acute respiratory failure, but efforts should focus on weaning the patient from mechanical ventilation as rapidly as possible after recovery. Because complicationswith extubation failure are high and may increase morbidity and mortality, prevention of extubation failure is critically important. We applied BiPAP, a noninvasive mode of pressure support ventilation, in an attempt to decrease the rate of reintubation. Methods: We prospectively enrolled 100 patients who had undergone extubation by T-piece weaning for 2 h. After extubation, patients were randomly divided into 2 groups with an O2 mask ormask-BiPAP. Results: Extubation was successful in 85 patients (85%) and failed in 15 patients (15%). The extubation failure ratewas 18%in themask-BiPAP study group and 12% in the O2-mask control group, a difference that was not statistically significant. Among the 15 patients in whom extubation failed, 6 required reintubation and 2 died (2/15; 13.33%), but the reintubation rate (6/15; 40%) could have been reduced. Conclusion: Noninvasive ventilation did not affect the outcome of extubation after the 2-h T-piece trial.

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