https://scholars.lib.ntu.edu.tw/handle/123456789/520880
標題: | An Integrative Index for Predicting Extubation Outcomes After Successful Completion of a Spontaneous Breathing Trial in an Adult Medical Intensive Care Unit | 作者: | Wu T.-J. JUDITH SHU-CHU SHIAO Yu H.-L. Lai R.-S. |
關鍵字: | endotracheal extubation; integrative index; intensive care unit; mechanical ventilation; rapid shallow breathing index; ventilator weaning | 公開日期: | 2019 | 卷: | 34 | 期: | 8 | 起(迄)頁: | 640-645 | 來源出版物: | Journal of Intensive Care Medicine | 摘要: | Background: Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients’ alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI. Methods: This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes. Results: Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ? 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, P =.026). Conclusion: The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU. ? The Author(s) 2017. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/520880 | ISSN: | 8850666 | DOI: | 10.1177/0885066617706688 | SDG/關鍵字: | bicarbonate; hemoglobin; serum albumin; biological marker; hemoglobin; serum albumin; aged; alertness; Article; artificial ventilation; asthma; breathing; chronic obstructive lung disease; congestive heart failure; consciousness; dyspnea; endotracheal intubation; extubation; Glasgow coma scale; heart rate; hospital mortality; human; hypoxemia; major clinical study; maximal expiratory pressure; maximal inspiratory pressure; observational study; oxygen saturation; pneumonia; priority journal; prospective study; rapid shallow breathing index; receiver operating characteristic; residual volume; respiratory acidosis; respiratory tract disease; sensitivity and specificity; sepsis; systolic blood pressure; weaning; adult; area under the curve; blood; clinical decision making; extubation; female; intensive care; intensive care unit; male; metabolism; procedures; retrospective study; severity of illness index; statistical model; ventilator weaning; Adult; Airway Extubation; Area Under Curve; Biomarkers; Clinical Decision Rules; Clinical Decision-Making; Critical Care; Female; Glasgow Coma Scale; Hemoglobins; Humans; Intensive Care Units; Logistic Models; Male; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Serum Albumin; Severity of Illness Index; Ventilator Weaning |
顯示於: | 護理學系所 |
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