创伤性脊髓损伤后机械通气——基于多中心队列研究的断奶成功预测模型:BICYCLE评分。

IF 6.8 2区 医学 Q1 RESPIRATORY SYSTEM Annals of the American Thoracic Society Pub Date : 2023-08-01 DOI:10.1513/AnnalsATS.202301-022OC
Annia F Schreiber, Jacopo Garlasco, Martin Urner, Amanda McFarlan, Andrew Baker, Andrea Rigamonti, Jeffrey M Singh, Demetrios James Kutsogiannis, Laurent J Brochard
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引用次数: 0

摘要

理由:关于脊髓损伤患者脱离机械通气的流行病学、结局和预测因素的信息有限。目的:我们的目的是研究创伤性脊髓损伤(tSCI)患者断奶结局的预测因素,并开发和验证预后模型和断奶成功评分。方法:这是一项基于登记的多中心队列研究,包括所有需要机械通气(MV)的成年tSCI患者,并于2005年至2019年期间入住圣迈克尔医院(多伦多,安大略省,加拿大)创伤登记处和加拿大里克汉森脊髓损伤登记处的重症监护病房(icu)之一。主要结局是在ICU出院时成功脱机。次要结局包括第14天和第28天断奶成功、考虑竞争死亡风险的从MV中解脱的时间,以及第28天和第60天无呼吸机天数。基线特征与断奶成功或从MV中解脱的时间之间的关联使用多变量逻辑回归和竞争风险回归进行测量。我们开发了一个预测断奶成功和ICU出院的简约模型,并通过bootstrap进行了验证。推导出ICU出院时断奶成功的预测评分,采用受试者工作特征曲线分析评估其判别能力,并与损伤严重程度评分(ISS)进行比较。结果:在分析的459例患者中,第14天、第28天和ICU出院时,分别有246例(53.6%)、302例(65.8%)和331例(72.1%)患者存活和无MV;54例(11.8%)在ICU死亡。从MV中解脱的平均时间为12天。与断奶成功相关的因素有:钝性损伤(优势比[OR], 2.96;P = 0.010), iss (or, 0.98;P = 0.025),完全综合征(OR, 0.53;P = 0.009),年龄(OR, 0.98;P = 0.003),宫颈病变(OR, 0.60;p = 0.045)。BICYCLE评分显示曲线下面积大于ISS(0.689[95%可信区间(CI), 0.631-0.743]比0.537 [95% CI, 0.479-0.595];结论:在一项大型多中心队列研究中,72%的tSCI患者成功断奶并从ICU存活出院。容易获得的入院特征可以合理地预测断奶成功率并有助于预后。
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Mechanical Ventilation after Traumatic Spinal Cord Injury-A Multicentric Cohort Study-based Prediction Model for Weaning Success: The BICYCLE Score.

Rationale: Limited information exists about the epidemiology, outcomes, and predictors of weaning from mechanical ventilation in patients with spinal cord injury. Objectives: Our aim was to investigate predictors of weaning outcomes for patients with traumatic spinal cord injury (tSCI) and develop and validate a prognostic model and score for weaning success. Methods: This was a registry-based, multicentric cohort study including all adult patients with tSCI requiring mechanical ventilation (MV) and admitted to one of the intensive care units (ICUs) of the Trauma Registry at St. Michael's Hospital (Toronto, ON, Canada) and the Canadian Rick Hansen Spinal Cord Injury Registry between 2005 and 2019. The primary outcome was weaning success from MV at ICU discharge. Secondary outcomes included weaning success at Days 14 and 28, time to liberation from MV accounting for competing risk of death, and ventilator-free days at 28 and 60 days. Associations between baseline characteristics and weaning success or time to liberation from MV were measured using multivariable logistic and competing risk regressions. A parsimonious model to predict weaning success and ICU discharge was developed and validated via bootstrap. A prediction score for weaning success at ICU discharge was derived, and its discriminative ability was assessed using receiver operating characteristic curve analysis and compared with the Injury Severity Score (ISS). Results: Of 459 patients analyzed, 246 (53.6%), 302 (65.8%), and 331 (72.1%) were alive and free of MV at Day 14, Day 28, and ICU discharge, respectively; 54 (11.8%) died in the ICU. Median time to liberation from MV was 12 days. Factors associated with weaning success were Blunt injury (odds ratio [OR], 2.96; P = 0.010), ISS (OR, 0.98; P = 0.025), Complete syndrome (OR, 0.53; P = 0.009), age in Years (OR, 0.98; P = 0.003), and Cervical LEsion (OR, 0.60; P = 0.045). The BICYCLE score showed a greater area under the curve than the ISS (0.689 [95% confidence interval (CI), 0.631-0.743] vs. 0.537 [95% CI, 0.479-0.595]; P < 0.0001). Factors predicting weaning success also predicted time to liberation. Conclusions: In a large multicentric cohort, 72% of patients with tSCI were weaned and discharged alive from the ICU. Readily available admission characteristics can reasonably predict weaning success and help prognostication.

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来源期刊
Annals of the American Thoracic Society
Annals of the American Thoracic Society Medicine-Pulmonary and Respiratory Medicine
CiteScore
9.30
自引率
3.60%
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0
期刊介绍: The Annals of the American Thoracic Society (AnnalsATS) is the official international online journal of the American Thoracic Society. Formerly known as PATS, it provides comprehensive and authoritative coverage of a wide range of topics in adult and pediatric pulmonary medicine, respiratory sleep medicine, and adult medical critical care. As a leading journal in its field, AnnalsATS offers up-to-date and reliable information that is directly applicable to clinical practice. It serves as a valuable resource for clinical specialists, supporting their formative and continuing education. Additionally, the journal is committed to promoting public health by publishing research and articles that contribute to the advancement of knowledge in these fields.
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