https://scholars.lib.ntu.edu.tw/handle/123456789/515235
標題: | Association of weaning preparedness with extubation outcome of mechanically ventilated patients in medical intensive care units: A retrospective analysis | 作者: | Lin F.-C. YAO-WEN KUO JIH-SHUIN JERNG HUEY-DONG WU |
公開日期: | 2020 | 出版社: | PeerJ Inc. | 卷: | 2020 | 期: | 4 | 起(迄)頁: | 8973 | 來源出版物: | PeerJ | 摘要: | Background: Assessment of preparedness of weaning has been recommended before extubation for mechanically ventilated patients. We aimed to understand the association of a structured assessment of weaning preparedness with successful liberation. Methods: We retrospectively investigated patients with acute respiratory failure who experienced an extubation trial at the medical intensive care units of a medical center and compared the demographic and clinical characteristics between those patients with successful and failed extubation. A composite score to assess the preparedness of weaning, the WEANSNOW score, was generated consisting of eight components, including Weaning parameters, Endotracheal tube, Arterial blood gas analysis, Nutrition, Secretions, Neuromuscular-affecting agents, Obstructive airway problems and Wakefulness. The prognostic ability of the WEANSNOW score for extubation was then analyzed. Results: Of the 205 patients included, 138 (67.3%) patients had successful extubation. Compared with the failure group, the success group had a significantly shorter duration of MV before the weaning attempt (11.2 ± 11.6 vs. 31.7 ± 26.2 days, p < 0.001), more with congestive heart failure (42.0% vs. 25.4%, p = 0.020), and had different distribution of the types of acute respiratory failure (p = 0.037). The failure group also had a higherWEANSNOW score (1.22 ± 0.85 vs. 0.51 ± 0.71, p < 0.001) and worse Rapid Shallow Breathing Index (93.9 ± 63.8 vs. 56.3 ± 35.1, p < 0.001). Multivariate logistic regression analysis showed that a WEANSNOW Score = 1 or higher (OR = 2.880 (95% CI [1.291-6.426]), p = 0.010) and intubation duration >21 days (OR = 7.752 (95% CI [3.560-16.879]), p < 0.001) were independently associated with an increased probability of extubation failure. Conclusion: Assessing the pre-extubation status of intubated patients in a checklist-based approach using the WEANSNOW score might provide valuable insights into extubation failure in patients in a medical ICU for acute respiratory failure. Further prospective studies are warranted to elucidate the practice of assessing weaning preparedness. ? 2020 Lin et al. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85083648996&doi=10.7717%2fpeerj.8973&partnerID=40&md5=8290a868a6eb29dddab1c145b3e91b12 https://scholars.lib.ntu.edu.tw/handle/123456789/515235 |
ISSN: | 2167-8359 | DOI: | 10.7717/peerj.8973 | SDG/關鍵字: | acute respiratory failure; adult; aged; arterial gas; Article; artificial ventilation; comparative study; confidence interval; congestive heart failure; controlled study; extubation; female; gas analysis; human; intensive care unit; major clinical study; male; maximal expiratory pressure; maximal inspiratory pressure; middle aged; neuromuscular function; nutrition; obstructive airway disease; outcome assessment; positive end expiratory pressure; rapid shallow breathing index; regression analysis; respiratory care; respiratory tract disease assessment; retrospective study; scoring system; secretion (process); sensitivity analysis; tidal volume; very elderly; wakefulness; weaning; WEANSNOW score |
顯示於: | 醫學系 |
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