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來源資料
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頁籤選單縮合
題 名 | Non-Invasive Ventilation in the Management of Postextubation Respiratory Distress, a Retrospective Study=拔管後呼吸窘迫呼吸處置之回溯性研究 |
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作 者 | 汪性寧; 葉育雯; 徐培菘; 賴君宇; 江俊松; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 13:1 2014.01[民103.01] |
頁 次 | 頁1-12 |
分類號 | 415.415 |
關鍵詞 | 非侵襲性呼吸器; 脫離; 呼吸窘迫; 重插管; Noninvasive ventilator; Weaning; Respiratory distress; Re-intubation; |
語 文 | 英文(English) |
中文摘要 | 研究目的:呼吸衰竭使用侵襲性呼吸器的病人在脫離呼吸器或拔管後時常會有呼吸窘迫發生。當呼吸窘迫發生時如果病患暫無生命危險,臨床醫師可判斷選擇使用非侵襲性呼吸器(Noninvasive Ventilators,NIV)或是直接重插管使用呼吸器。本回溯性研究,旨在比較這兩種治療方式在處理拔管後呼吸窘迫後續處置的結果與存活率影響的因子。研究方法:我們回溯性收集兩年期間北部某醫學中心加護病房拔管後呼吸窘迫,總共 131位病人的資料,其中拔管後呼吸窘迫使用 NIV有 67位;直接插管使用呼吸器有 64位。資料包含性別、年齡、體重、淺快呼吸指數,呼吸窘迫發生到介入時間( Tinv)、拔管後 28天期間內( >28天病人下轉 RCW,資料取得不易)沒有使用呼吸器的時間累計 (Temvf)。以統計方法分析何種因子會影響其成功脫離呼吸器並存活的結果。研究結果:拔管後呼吸窘迫使用 NIV的族群有較低的重插管率 (p<0.01),較長的停用呼吸器時間 (Temvf) (p<0.01)以及最終 28天時有較長的存活率。單變項分析呼吸器停用之 28天,我們發現 NIV (p<0.01)及重插管 (p<0.01)與最後脫離結果明顯相關。以上有統計學上顯著差異的二變項,進一步以多變項邏輯回歸分析,發現呼吸器停用之 28天結束時且存活之最佳預測指標就是減少重插管率(OR:7.74 p<0.01)。結論與建議:在我們的研究中指出,拔管後呼吸窘迫儘早使用 NIV,可以明顯降低重插管率而且與成功脫離呼吸器並存活之結果是密切相關的。 |
英文摘要 | BACKGROUND AND OBJECTIVE: Respiratory distress occurs frequently in patients after extubation and disconnection from mechanical ventilation. As long as it is not immediately life-threatening, physicians often have the choice of either a trial of noninvasive ventilation (NIV) or direct re-intubation. This retrospective study aimed to compare these two treatment options in managing post-extubation respiratory distress in terms of weaning outcome and survival. METHODS: Patients with post-extubation respiratory distress in intensive care units (ICU) over a 2-year period were enrolled in the study retrospectively by chart review. A total of 131 patients who experienced respiratory distress after extubation were screened. Among them, 67 patients were placed on NIV when respiratory distress occurred post-extubation, while 64 patients were directly re-intubated. Parameters analyzed included time to intervention after post-extubation respiratory distress (Tinv), time to re-intubation (Treint) and cumulative ventilator-free days after extubation in a 28-day period (Temvf). RESULTS: Patients with post-extubation distress who were placed on NIV had lower rate of re-intubation (p<0.01), longer Temvf (p<0.01), and higher probability of ventilator-independent survival at the end of 28 days. Using univariate analysis of variables for endotracheal mechanical ventilation free survival in 28 days, we found that NIV(p<0.01) and re-intubation rate(p<0.01)were significantly correlated with final outcomes of weaning. Further analysis with multivariate logistic regression found that reduced rate of re-intubation was most predictive of ventilator-free survival at the end of 28 days (OR: 7.74, p<0.01). CONCLUSION: In our study, we demonstrated that early use of NIV in this situation can significantly reduce the rate of re-intubation and is associated with better weaning outcome and increased ventilator-independent survival. |
本系統中英文摘要資訊取自各篇刊載內容。