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頁籤選單縮合
題名 | Respiratory Management after Self-Extubation=自拔氣管內管後呼吸處置 |
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作者 | 江俊松; 高尚志; 林嘉謨; 葉育雯; Jiang, Jiunn-song; Kao, Shang-jyh; Lin, Chia-mo; Yeh, Yu-wung; |
期刊 | 臺灣醫學會雜誌 |
出版日期 | 20000900 |
卷期 | 99:9 2000.09[民89.09] |
頁次 | 頁689-692 |
分類號 | 415.3 |
語文 | eng |
關鍵詞 | 氣管內管; 呼吸; Respiration; Artificial intubation; Intratracheal ventilator weaning; Self-extubation; |
英文摘要 | Background and purpose: Self-extubation is a potentially life-threatening event, but may also provide an opportunity to wean patients who should have been extubated earlier. The purpose of this study was to determine the risk factors for re-intubation after self-extubation. Methods: The medical charts of 69 self-extubated patients treated in Shin Kong Hospital, Taipei, from September 1996 through August 1998 were reviewed. Demographic data, ventilator settings before self-extubation, arterial blood gas values, and the type of respiratory management used after self-extubation were examined to determine their association with re-intubation. Reaults: Of the 69 self-extubated patients, 38 fared well without further ventilatory support after self-extubation. Four factors were associated with extubation outcome: 1) mean pre-extubation FiO2 (fraction of inspired oxygen), which was significantly higher in the re-intubated group (RI) than in the not re-intubated group (NRI) (0.48 vs 0.33, p=0.002)-all self-extubated patients receiving an FiO2 of more than 0.40 were re-intubated; 2) PaO2/FiO2 (ratio of arterial oxygen tension to inspired oxygen concentration), which was lower in the RI group than in the NRI group (259.4 vs 346.4, p=0.005); 3) requirement for assist/control ventiatory mode-patients needing this type of ventilatory support had a greater likelihood of re-intubation than those requiring partial ventilatory support (odds ratio [OR], 3.790; confidence interval [Cl], 1.055-13.621; p=0.041); and 4) female sex (OR 0.188; CI 0.048-0.732, p=0.016). Conclusions: About half of self-extubated patients may not require re-intubation. Pre-extubation FiO2, PaO2/FiO2, and ventilator mode, as well as gender, may be useful in determining the likelihood that a self-extubated patient will require re-intubation. |
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