危重病人正压拔管与传统拔管的比较——一项随机对照研究。

IF 1.6 Q2 ANESTHESIOLOGY Anaesthesiology intensive therapy Pub Date : 2023-01-01 DOI:10.5114/ait.2023.125584
Ajeetviswanath Thanjavur Prabhakaran, Darlong Vanalal, Kapil Soni, Dalim Baidya, Richa Aggarwal, Harsha Binu, Shivanand Gamanagatti, Maya Dehran, Anjan Trikha
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引用次数: 0

摘要

背景:在重症监护病房(ICU)常用两种拔管方法:传统的气管内吸痰法和不吸痰的正压法。在实验室研究中,使用后者的生理效果更好,因为在气管内管和喉部之间通过的空气将收集的声门下分泌物推出,这些分泌物可以被吸入。方法:将70例三级ICU机械通气患者随机分为两组,每组35例。在自主呼吸试验(SBT)结束时,正压拔管(PPE)组给予15 cm h2o的压力支持,呼气末正压10 cm h2o持续5分钟,而另一组(传统拔管- TE)则直接拔管。比较两组患者肺超声评分(LUS)、胸片表现、肺泡动脉氧梯度变化、不良临床事件、无icu天数及再插管率。结果:两组在SBT结束时的中位LUS相似。然而,PPE组拔管后30分钟、6小时、24小时的中位LUS [5 (4-8) (P = 0.04)、5 (3-8)(P = 0.02)、4 (3-7)(P = 0.02)]明显低于TE组[6(6-8)、6(5-7.5)、6(5-7.5)]。PPE组在24小时结束时评分持续下降,无临床不良事件的患者比例明显高于PPE组(80% vs. 57.14%, P = 0.04)。结论:研究表明正压拔管是一种安全的操作,可以改善通气,减少不良事件。
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Comparison of positive pressure extubation with traditional extubation in critically ill patients - a randomised control study.

Background: Two extubation methods are commonly used in the intensive care unit (ICU): the traditional method with endotracheal suctioning and the positive- pressure method without suctioning. Better physiological outcomes were found in lab studies using the latter, as the air passing between the endotracheal tube and the larynx pushes out the collected subglottic secretions, which can be suctioned.

Methods: 70 mechanically ventilated patients in a tertiary ICU were randomised into 2 groups of 35 patients each. At the end of the spontaneous breathing trial (SBT), the positive pressure extubation (PPE) group was given a pressure support of 15 cm H 2 O and a positive end expiratory pressure of 10 cm H 2 O for 5 minutes while the other group (traditional extubation - TE) was extubated directly. We compared the lung ultrasound scores (LUS), chest X-ray findings, alveolar arterial oxygen gradient changes, adverse clinical events, ICU-free days and reintubation rates between the two groups.

Results: Median LUS at the end of the SBT was similar between the two groups. However, the median post-extubation LUS at 30 minutes, 6 hours, 24 hours in the PPE group [5 (4-8) ( P = 0.04), 5 (3-8) ( P = 0.02), 4 (3-7) ( P = 0.02), respectively] were significantly lower compared to the TE group [6 (6-8), 6 (5-7.5), 6 (5-7.5), respectively]. There was a persistent lowering of the scores even at the end of 24 hours in the PPE group, while the percentage of patients without adverse clinical events was significantly higher (80% vs. 57.14%, P = 0.04).

Conclusions: The study shows that positive pressure extubation is a safe procedure which improves aeration and reduces adverse events.

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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
48
审稿时长
25 weeks
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