Analysis of Factors and Clinical Outcomes of Planned Tracheal Extubation Failure in Neurosurgical Intensive Care Unit Patients.

Haotian Wu, Jinsong Shen, Yan Xu
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Abstract

Abstract: BACKGROUND: Planned tracheal extubation failure is a common occurrence among patients in the neurosurgical intensive care unit (NICU) because of the complex nature of neurocritical injuries, and the failure could result in a poor prognosis. METHODS: We observed and recorded the patients with tracheal intubation in the NICU of a hospital in Shanghai from June 2021 to December 2022 and analyzed data from planned tracheal extubation, categorizing patients by success or failure, and compared outcomes between the two groups while investigating contributing factors. RESULTS: A total of 156 patients were included, 133 (85.3%) of whom were successfully extubated and 23 (14.7%) were not. The results of logistic regression analysis demonstrated that the Glasgow Coma Scale score before extubation (OR, 0.643; 95% CI, 0.444-0.931; P = .020) and the frequency of respiratory secretions suctioning before tracheal extubation (OR, 0.098; 95% CI, 0.027-0.354; P < .001) were independent risk factors for extubation failure. We also found that the extubation failure group experienced a significantly longer ICU stay and incurred higher hospitalization costs. CONCLUSIONS: Poor Glasgow Coma Scale scores and a high frequency of respiratory secretions suctioning before tracheal extubation were the main factors contributing to tracheal extubation failure in NICU patients. To avoid tracheal extubation failure and adverse outcomes, these two factors should be carefully assessed before tracheal extubation.

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神经外科重症监护病房患者计划气管插管失败的因素和临床结果分析。
摘要:背景:由于神经重症损伤的复杂性,计划性气管插管失败是神经外科重症监护病房(NICU)患者的常见情况,失败可能导致预后不良。方法:我们观察并记录了 2021 年 6 月至 2022 年 12 月期间上海某医院 NICU 的气管插管患者,分析了计划气管拔管的数据,将患者按成功或失败进行分类,并比较了两组患者的结局,同时调查了诱因。结果:共纳入 156 例患者,其中 133 例(85.3%)成功拔管,23 例(14.7%)未成功拔管。逻辑回归分析结果显示,拔管前格拉斯哥昏迷量表评分(OR,0.643;95% CI,0.444-0.931;P = .020)和气管插管前呼吸道分泌物抽吸频率(OR,0.098;95% CI,0.027-0.354;P < .001)是拔管失败的独立风险因素。我们还发现,拔管失败组的重症监护室住院时间明显更长,住院费用也更高。结论:格拉斯哥昏迷量表评分差和气管插管前呼吸道分泌物抽吸频率高是导致 NICU 患者气管插管失败的主要因素。为避免气管插管失败和不良后果,在气管插管前应仔细评估这两个因素。
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