背景:尽管拔管失败的原因很多,拔管前24小时维持负或低正体液平衡可能是成功拔管的关键措施.
目的:评估重症监护病房(ICU)机械通气患者拔管前液体平衡的预测价值及其转归。
方法:本回顾性队列研究收集了2022年1月至2022年12月在兰州普通成人ICU接受机械通气患者的临床资料。根据拔管结果,将患者分为拔管成功组和拔管失败组。比较拔管前24h的液体平衡水平,分析液体平衡对机械通气患者拔管结果的预测价值。
结果:在这项研究中,我们收集了入住普通成人ICU的545例患者的临床数据.根据纳入和排除标准,265例(48.6%)患者被纳入,其中197例(74.3%)成功拔管;68例(25.7%)患者拔管不成功。拔管失败组患者拔管前24h的总摄入量和液体平衡水平明显高于拔管成功组,中位数为2679.00(2410.44-3193.50)mL与2435.40(1805.04-2957.00)mL,831.50(26.25-1407.94)mL与346.00(-163.00-941.50)mL。受试者工作特征(ROC)曲线分析表明,预测拔管结果的最佳临界值为497.5mL(灵敏度为64.7%,特异性59.4%),用于拔管前24小时的液体平衡。ROC曲线下面积为0.627(95%置信区间[CI]0.547-0.707)。基于Logistic回归模型,拔管前24小时累积液体平衡>497.5mL可以预测ICU机械通气患者的预后(OR=5.591,95%CI[2.402-13.015],p<.05)。
结论:ICU机械通气患者拔管前24h的液体平衡水平与拔管结果相关。当液体平衡水平>497.5mL时,拔管失败的风险更高。
结论:气管插管是许多危重病人的重要生命支持技术,确定拔管的适当时间仍然是临床医生面临的挑战。虽然拔管失败的原因很多,持续液体平衡和容量超负荷引起的急性肺水肿是拔管失败的主要原因之一。因此,研究液体平衡与拔管结局的关系对改善ICU有创机械通气患者的预后非常重要。
BACKGROUND: Although there are many reasons for extubation failure, maintaining negative or lower positive fluid balances 24 hours before
extubation may be a key measure for successful
extubation.
OBJECTIVE: To assess the predictive value of fluid balance before extubation and its outcome in mechanically ventilated cases in the intensive care unit (ICU).
METHODS: This retrospective cohort study involved collecting clinical data from patients undergoing mechanical ventilation in Lanzhou general adult ICU from January 2022 to December 2022. Based on
extubation outcomes, the patients were divided into a successful
extubation group and a failed
extubation group. Their fluid balance levels 24 h before extubation were compared with analyse the predictive value of fluid balance on extubation outcomes in patients undergoing mechanical ventilation.
RESULTS: In this study, clinical data from 545 patients admitted to a general adult ICU were collected. According to the inclusion and exclusion criteria, 265 (48.6%) patients were included, of which 197 (74.3%) were successfully extubated; extubation was unsuccessful in 68 (25.7%) patients. The total intake and fluid balance levels in patients in the failed
extubation group 24 h before
extubation were significantly higher than those in the successful extubation group, with a median of 2679.00 (2410.44-3193.50) mL versus 2435.40 (1805.04-2957.00) mL, 831.50 (26.25-1407.94) mL versus 346.00 (-163.00-941.50) mL. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for predicting extubation outcomes was 497.5 mL (sensitivity 64.7%, specificity 59.4%) for fluid balance 24 h before extubation. The area under the ROC curve was 0.627 (95% confidence interval [CI] 0.547-0.707). Based on the logistic regression model, cumulative fluid balance >497.5 mL 24 h before extubation could predict its outcomes in mechanically ventilated patients in the ICU (OR = 5.591, 95% CI [2.402-13.015], p < .05).
CONCLUSIONS: The fluid balance level 24 h before extubation was correlated with the outcome of
extubation in mechanically ventilated patients in the ICU. The risk of extubation failure was higher when the fluid balance level was >497.5 mL.
CONCLUSIONS: Tracheal intubation is a crucial life support technique for many critically ill patients, and determining the appropriate time for extubation remains a challenge for clinicians. Although there are many reasons for extubation failure, acute pulmonary oedema caused by continuous positive fluid balance and volume overload is one of the main reasons for extubation failure. Therefore, it is very important to study the relationship between fluid balance and extubation outcome to improve the prognosis of patients with invasive mechanical ventilation in ICU.