PDF(Pubmed)
Abstract：
OBJECTIVE: We aimed to evaluate the ability of the peripheral perfusion index (PPI) to predict reintubation of critically ill surgical patients.
METHODS: This prospective observational study included mechanically ventilated adults who were extubated after a successful spontaneous breathing trial (SBT). The patients were followed up for the next 48 h for the need for reintubation. The heart rate, systolic blood pressure, respiratory rate, peripheral arterial oxygen saturation (SpO2), and PPI were measured before-, at the end of SBT, 1 and 2 h postextubation. The primary outcome was the ability of PPI 1 h postextubation to predict reintubation using area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariate analyses were performed to identify predictors for reintubation.
RESULTS: Data from 62 patients were analysed. Reintubation occurred in 12/62 (19%) of the patients. Reintubated patients had higher heart rate and respiratory rate; and lower SpO2 and PPI than successfully weaned patients. The AUC (95%confidence interval) for the ability of PPI at 1 h postextubation to predict reintubation was 0.82 (0.71-0.91) with a negative predictive value of 97%, at a cutoff value of ≤ 2.5. Low PPI and high respiratory rate were the independent predictors for reintubation.
CONCLUSIONS: PPI early after extubation is a useful tool for prediction of reintubation. Low PPI is an independent risk factor for reintubation. A PPI > 2.5, one hour after extubation can confirm successful extubation.
METHODS: This prospective observational study included mechanically ventilated adults who were extubated after a successful spontaneous breathing trial (SBT). The patients were followed up for the next 48 h for the need for reintubation. The heart rate, systolic blood pressure, respiratory rate, peripheral arterial oxygen saturation (SpO2), and PPI were measured before-, at the end of SBT, 1 and 2 h postextubation. The primary outcome was the ability of PPI 1 h postextubation to predict reintubation using area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariate analyses were performed to identify predictors for reintubation.
RESULTS: Data from 62 patients were analysed. Reintubation occurred in 12/62 (19%) of the patients. Reintubated patients had higher heart rate and respiratory rate; and lower SpO2 and PPI than successfully weaned patients. The AUC (95%confidence interval) for the ability of PPI at 1 h postextubation to predict reintubation was 0.82 (0.71-0.91) with a negative predictive value of 97%, at a cutoff value of ≤ 2.5. Low PPI and high respiratory rate were the independent predictors for reintubation.
CONCLUSIONS: PPI early after extubation is a useful tool for prediction of reintubation. Low PPI is an independent risk factor for reintubation. A PPI > 2.5, one hour after extubation can confirm successful extubation.
摘要：
目的：我们旨在评估外周灌注指数（PPI）预测危重手术患者再插管的能力。
方法：这项前瞻性观察研究包括在成功自主呼吸试验（SBT）后拔管的机械通气成人。在接下来的48小时内对患者进行了随访，以需要重新插管。心率,收缩压,呼吸频率,外周动脉血氧饱和度(SpO2),和PPI是在之前测量的-，在SBT结束时，拔管后1和2小时。主要结果是拔管后1小时PPI使用接受者工作特征曲线下面积（AUC）分析预测再插管的能力。进行单变量和多变量分析以确定再插管的预测因子。
结果：分析了62例患者的数据。12/62（19％）的患者发生了重新插管。与成功断奶的患者相比，重新插管的患者心率和呼吸频率更高；SpO2和PPI更低。拔管后1小时PPI预测再插管能力的AUC（95％置信区间）为0.82（0.71-0.91），阴性预测值为97％，在≤2.5的截止值。低PPI和高呼吸频率是再插管的独立预测因素。
结论：拔管后早期PPI是预测再插管的有用工具。低PPI是再插管的独立危险因素。一PPI>2.5，拔管后一小时可确认拔管成功。
方法：这项前瞻性观察研究包括在成功自主呼吸试验（SBT）后拔管的机械通气成人。在接下来的48小时内对患者进行了随访，以需要重新插管。心率,收缩压,呼吸频率,外周动脉血氧饱和度(SpO2),和PPI是在之前测量的-，在SBT结束时，拔管后1和2小时。主要结果是拔管后1小时PPI使用接受者工作特征曲线下面积（AUC）分析预测再插管的能力。进行单变量和多变量分析以确定再插管的预测因子。
结果：分析了62例患者的数据。12/62（19％）的患者发生了重新插管。与成功断奶的患者相比，重新插管的患者心率和呼吸频率更高；SpO2和PPI更低。拔管后1小时PPI预测再插管能力的AUC（95％置信区间）为0.82（0.71-0.91），阴性预测值为97％，在≤2.5的截止值。低PPI和高呼吸频率是再插管的独立预测因素。
结论：拔管后早期PPI是预测再插管的有用工具。低PPI是再插管的独立危险因素。一PPI>2.5，拔管后一小时可确认拔管成功。
