PDF(Pubmed)
Abstract：
BACKGROUND: Re-intubation is necessary in 2% to 30% of cases of patients receiving a planned extubation. This procedure is associated with prolonged mechanical ventilation, a greater need for tracheostomy, a higher incidence of ventilator-associated pneumonia, and higher mortality. The aim of this study was to evaluate the effect of re-intubation within 48 h on mortality after planned extubation by using a randomized controlled trial database.
METHODS: Secondary analysis of a multi-center randomized trial, which evaluated the effect of reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial, followed by extubation. The study included adult subjects who received invasive mechanical ventilation for > 12 h. The subjects were divided into an extubation failure group and an extubation success group. The outcome was in-hospital mortality. Two multivariate logistic regression models were constructed to identify independent factors associated with mortality.
RESULTS: Among the 336 subjects studied, extubation failed in 52 (15.4%) and they were re-intubated within 48 h. Most re-intubations occurred between 12 and 24 h after planned extubation (median [interquartile range] 16 [6-36] h). Mortality of the extubation failure group was higher both in the ICU (32.6% vs 6.6%; odds ratio [OR] 6.77, 95% CI 3.22-14.24; P < .001) and in-hospital (42.3% vs 14.0%; OR 4.47, 95% CI 2.34-8.51; P < .001) versus the extubation success group. Multivariate logistic regression analyses showed that re-intubation within 48 h was independently associated with both ICU mortality (OR 6.10, 95% CI 2.84-13.07; P < .001) and in-hospital mortality (OR 3.36, 95% CI 1.67-6.73; P = .001). In-hospital mortality was also associated with rescue noninvasive ventilation after extubation (OR 2.44, 95% CI 1.25-4.75; P = .009).
CONCLUSIONS: Re-intubation within 48 h after planned extubation was associated with mortality in subjects who were critically ill.
METHODS: Secondary analysis of a multi-center randomized trial, which evaluated the effect of reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial, followed by extubation. The study included adult subjects who received invasive mechanical ventilation for > 12 h. The subjects were divided into an extubation failure group and an extubation success group. The outcome was in-hospital mortality. Two multivariate logistic regression models were constructed to identify independent factors associated with mortality.
RESULTS: Among the 336 subjects studied, extubation failed in 52 (15.4%) and they were re-intubated within 48 h. Most re-intubations occurred between 12 and 24 h after planned extubation (median [interquartile range] 16 [6-36] h). Mortality of the extubation failure group was higher both in the ICU (32.6% vs 6.6%; odds ratio [OR] 6.77, 95% CI 3.22-14.24; P < .001) and in-hospital (42.3% vs 14.0%; OR 4.47, 95% CI 2.34-8.51; P < .001) versus the extubation success group. Multivariate logistic regression analyses showed that re-intubation within 48 h was independently associated with both ICU mortality (OR 6.10, 95% CI 2.84-13.07; P < .001) and in-hospital mortality (OR 3.36, 95% CI 1.67-6.73; P = .001). In-hospital mortality was also associated with rescue noninvasive ventilation after extubation (OR 2.44, 95% CI 1.25-4.75; P = .009).
CONCLUSIONS: Re-intubation within 48 h after planned extubation was associated with mortality in subjects who were critically ill.
摘要：
背景：在2％至30％的患者接受计划拔管的情况下，需要重新插管。该程序与长时间的机械通气有关，更需要气管造口术，呼吸机相关性肺炎的发病率较高，和更高的死亡率。这项研究的目的是通过使用随机对照试验数据库评估48h内重新插管对计划拔管后死亡率的影响。
方法：多中心随机试验的二次分析，评估了成功的自主呼吸试验后1小时重新连接机械通气的效果，然后是拔管。该研究包括接受有创机械通气>12小时的成年受试者。受试者被分为拔管失败组和拔管成功组。结果是院内死亡率。建立两个多变量逻辑回归模型以确定与死亡率相关的独立因素。
结果：在研究的336个受试者中，52例(15.4%)拔管失败,并在48h内重新插管。大多数重新插管发生在计划拔管后12-24h(中位数[四分位距]16[6-36]h).拔管失败组的死亡率在ICU（32.6％vs6.6％；比值比[OR]6.77，95％CI3.22-14.24；P<.001）和住院（42.3％vs14.0％；OR4.47，95％CI2.34-8.51；P<.001）均高于插管拔管成功组。多因素logistic回归分析显示，48h内再次插管与ICU死亡率（OR6.10，95％CI2.84-13.07；P<.001）和院内死亡率（OR3.36，95％CI1.67-6.73；P=.001）独立相关。院内死亡率也与拔管后无创通气相关（OR2.44，95％CI1.25-4.75；P=.009）。
结论：计划拔管后48小时内再次插管与危重患者的死亡率相关。
方法：多中心随机试验的二次分析，评估了成功的自主呼吸试验后1小时重新连接机械通气的效果，然后是拔管。该研究包括接受有创机械通气>12小时的成年受试者。受试者被分为拔管失败组和拔管成功组。结果是院内死亡率。建立两个多变量逻辑回归模型以确定与死亡率相关的独立因素。
结果：在研究的336个受试者中，52例(15.4%)拔管失败,并在48h内重新插管。大多数重新插管发生在计划拔管后12-24h(中位数[四分位距]16[6-36]h).拔管失败组的死亡率在ICU（32.6％vs6.6％；比值比[OR]6.77，95％CI3.22-14.24；P<.001）和住院（42.3％vs14.0％；OR4.47，95％CI2.34-8.51；P<.001）均高于插管拔管成功组。多因素logistic回归分析显示，48h内再次插管与ICU死亡率（OR6.10，95％CI2.84-13.07；P<.001）和院内死亡率（OR3.36，95％CI1.67-6.73；P=.001）独立相关。院内死亡率也与拔管后无创通气相关（OR2.44，95％CI1.25-4.75；P=.009）。
结论：计划拔管后48小时内再次插管与危重患者的死亡率相关。
