Role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation: A prospective cohort study

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2024-12-10 DOI:10.1016/j.jcrc.2024.154983

Jie Zhang , Qian Xie , Rong Jiang , Yang Yang , Yuting Yang , Chaoqi Zhou , Wei Zhang , Tian Zhang , Yixin Liu , Huiming Yao

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Abstract

Purpose

This study aims to evaluate the role of diaphragmatic dysfunction in extubation failure among patients at high risk of reintubation.

Material and methods

This prospective cohort study was carried out at a intensive care unit in China. Adult patients who had been intubated for more than 24 h and ready for extubation were included in the study if they exhibited a high risk of extubation failure. Diaphragm dysfunction was defined as a diaphragmatic thickening fraction <30 % or diaphragmatic excursion <10 mm. The primary outcome was defined as extubation failure, which includes either reintubation or death within the initial 7 days following extubation.

Results

Out of the 113 patients, 27 (23.89 %) experienced extubation failure, with diaphragm dysfunction diagnosed in 63 (55.75 %) individuals. Patients who failed extubation were significantly more likely to have diaphragm dysfunction (85.19 % vs. 46.51 %, p < 0.01). In the Cox-proportional hazards regression analysis, diaphragm dysfunction and the Medical Research Council score were found to be associated with extubation failure. The adjusted hazard ratios were 4.56 [95 % CI: 1.56–13.33] and 0.93 [95 % CI: 0.88–0.99]. Both variables were closely correlated with extubation failure showing statistical significance.

Conclusion

Diaphragm dysfunction could contribute to an elevated extubation failure rate.

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膈功能障碍在高危患者拔管失败中的作用：一项前瞻性队列研究。

目的：本研究旨在评估膈功能障碍在高危再插管患者拔管失败中的作用。材料和方法：本前瞻性队列研究在中国的重症监护病房进行。已插管超过24小时并准备拔管的成年患者，如果他们表现出拔管失败的高风险，则纳入研究。结果：113例患者中，27例（23.89%）出现拔管失败，63例（55.75%）诊断为膈功能障碍。拔管失败的患者更容易出现膈功能障碍（85.19% vs. 46.51%）。结论：膈功能障碍可能导致拔管失败率升高。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.