Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study
Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study
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DOI：
10.1186/s40560-020-00437-4
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发表时间：
2020-02-21
影响因子：
7.1
通讯作者：
Neurohr, Claus
中科院分区：
文献类型：
--
作者：
Ghiani, Alessandro;Paderewska, Joanna;Neurohr, Claus
背景 多项研究评估了短期机械通气患者脱机和拔管结果的预测因素，但关于长期机械通气脱机预测因素的研究很少。方法 在德国一家专门的国家断奶中心进行回顾性、单中心、观察性研究。对患者的医疗记录进行审查，以获得有关人口统计学、合并症、呼吸指数的数据，以及进入撤机中心后前瞻性记录的标准化自主呼吸试验（SBT）的结果。评估的呼吸指数是通气比（VR）和由计算的机械功率（MP）得出的参数。使用二元逻辑回归模型评估与长期脱机失败和 SBT 失败相关的预测因素。结果 对 263 名接受了 5 年以上长期机械通气、气管切开术的患者进行了分析。机械通气 3 周后，脱机不成功的患者 SBT 失败的频率更高，并且吸气气道正压、驱动压、VR、绝对 MP 和标准化为预测体重和动态肺胸顺应性 (LTC-MP) 的 MP 值显着增加。在逻辑回归分析中，与断奶失败独立相关的变量为女性（调整后优势比 0.532 [95% CI 0.291-0.973]；p = 0.040）、肥胖（体重指数 >= 30 kg/m(2)）（2.595 [1.210-5.562]；p = 0.014）、COPD（3.209） [1.563-6.589]；p = 0.002)，LTC-MP (3.470 [1.067-11.284]；p = 0.039)，机械通气时 PaCO2 (1.101 [95% CI 1.034-1.173]；p = 0.003)，以及 SBT 失败 (4.702) [2.250-9.825]；p < 0.001）。此外，女性（0.401 [0.216-0.745]；p = 0.004）、LTC-MP（3.017 [1.027-8.862]；p = 0.046）和机械通气 PaCO2（1.157 [1.083-1.235]；p < 0.001）是失败的独立危险因素。 SBT。结论 在本研究中，得出的脱机预测因素表明，自主呼吸过程中呼吸肌的工作负荷起着至关重要的作用。标准化为肺胸顺应性的机械功率与撤机结果独立相关，并且可以识别撤机失败高风险的患者。
Background Several studies have assessed predictors of weaning and extubation outcome in short-term mechanically ventilated patients, but there are only few studies on predictors of weaning from prolonged mechanical ventilation. Methods Retrospective, single-center, observational study at a specialized national weaning center in Germany. Patients' medical records were reviewed to obtain data on demographics, comorbidities, respiratory indices, and the result of a prospectively documented, standardized spontaneous breathing trial (SBT) upon admission to the weaning center. Respiratory indices assessed were the ventilatory ratio (VR) and parameters derived from calculated mechanical power (MP). Predictors associated with failure of prolonged weaning and failure of the SBT were assessed using a binary logistic regression model. Results A total of 263 prolonged mechanically ventilated, tracheotomized patients, treated over a 5-year period were analyzed. After 3 weeks of mechanical ventilation, patients with unsuccessful weaning failed a SBT more frequently and showed significantly increased values for inspiratory positive airway pressure, driving pressure, VR, absolute MP, and MP normalized to predicted body weight and dynamic lung-thorax compliance (LTC-MP). In the logistic regression analyses, variables independently correlated with weaning failure were female gender (adjusted odds ratio 0.532 [95% CI 0.291-0.973]; p = 0.040), obesity (body mass index >= 30 kg/m(2)) (2.595 [1.210-5.562]; p = 0.014), COPD (3.209 [1.563-6.589]; p = 0.002), LTC-MP (3.470 [1.067-11.284]; p = 0.039), PaCO2 on mechanical ventilation (1.101 [95% CI 1.034-1.173]; p = 0.003), and failure of the SBT (4.702 [2.250-9.825]; p < 0.001). In addition, female gender (0.401 [0.216-0.745]; p = 0.004), LTC-MP (3.017 [1.027-8.862]; p = 0.046), and PaCO2 on mechanical ventilation (1.157 [1.083-1.235]; p < 0.001) were independent risk factors for an unsuccessful SBT. Conclusions In the present study, the derived predictors of weaning point to a crucial role of the workload imposed on respiratory muscles during spontaneous breathing. Mechanical power normalized to lung-thorax compliance was independently correlated with weaning outcome and may identify patients at high risk for weaning failure.