在使用 T 片的呼吸机断奶过程中出现下垂与难以断奶患者的死亡率增加有关。

IF 3.8 2区医学 Q1 CRITICAL CARE MEDICINE

Journal of Intensive Care Pub Date : 2024-06-24 DOI:10.1186/s40560-024-00737-z

Wanglin Liu, Yi Chi, Yutong Zhao, Huaiwu He, Yun Long, Zhanqi Zhao

{"title":"在使用 T 片的呼吸机断奶过程中出现下垂与难以断奶患者的死亡率增加有关。","authors":"Wanglin Liu, Yi Chi, Yutong Zhao, Huaiwu He, Yun Long, Zhanqi Zhao","doi":"10.1186/s40560-024-00737-z","DOIUrl":null,"url":null,"abstract":"Background: Difficult-to-wean patients, typically identified as those failing the initial spontaneous breathing trial (SBT), face elevated mortality rates. Pendelluft, frequently observed in patients experiencing SBT failure, can be conveniently detected through bedside monitoring with electrical impedance tomography (EIT). This study aimed to explore the impact of pendelluft during SBT on difficult-to-wean patients.Methods: This retrospective observational study included difficult-to-wean patients undergoing spontaneous T piece breathing, during which EIT data were collected. Pendelluft occurrence was defined when its amplitude exceeded 2.5% of global tidal impedance variation. Physiological parameters during SBT were retrospectively retrieved from the EIT Examination Report Form. Other clinical data including mechanical ventilation duration, length of ICU stay, length of hospital stay, and 28-day mortality were retrieved from patient records in the hospital information system for each subject.Results: Pendelluft was observed in 72 (70.4%) of the 108 included patients, with 16 (14.8%) experiencing mortality by day 28. The pendelluft group exhibited significantly higher mortality (19.7% vs. 3.1%, p = 0.035), longer median mechanical ventilation duration [9 (5-15) vs. 7 (5-11) days, p = 0.041] and shorter ventilator-free days at day 28 [18 (4-22) vs. 20 (16-23) days, p = 0.043]. The presence of pendellfut was independently associated with increased mortality at day 28 (OR = 10.50, 95% confidence interval 1.21-90.99, p = 0.033).Conclusions: Pendelluft occurred in 70.4% of difficult-to-wean patients undergoing T piece spontaneous breathing. Pendelluft was associated with worse clinical outcomes, including prolonged mechanical ventilation and increased mortality in this population. Our findings underscore the significance of monitoring pendelluft using EIT during SBT for difficult-to-wean patients.","PeriodicalId":16123,"journal":{"name":"Journal of Intensive Care","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11194869/pdf/","citationCount":"0","resultStr":"{\"title\":\"Occurrence of pendelluft during ventilator weaning with T piece correlated with increased mortality in difficult-to-wean patients.\",\"authors\":\"Wanglin Liu, Yi Chi, Yutong Zhao, Huaiwu He, Yun Long, Zhanqi Zhao\",\"doi\":\"10.1186/s40560-024-00737-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Difficult-to-wean patients, typically identified as those failing the initial spontaneous breathing trial (SBT), face elevated mortality rates. Pendelluft, frequently observed in patients experiencing SBT failure, can be conveniently detected through bedside monitoring with electrical impedance tomography (EIT). This study aimed to explore the impact of pendelluft during SBT on difficult-to-wean patients.Methods: This retrospective observational study included difficult-to-wean patients undergoing spontaneous T piece breathing, during which EIT data were collected. Pendelluft occurrence was defined when its amplitude exceeded 2.5% of global tidal impedance variation. Physiological parameters during SBT were retrospectively retrieved from the EIT Examination Report Form. Other clinical data including mechanical ventilation duration, length of ICU stay, length of hospital stay, and 28-day mortality were retrieved from patient records in the hospital information system for each subject.Results: Pendelluft was observed in 72 (70.4%) of the 108 included patients, with 16 (14.8%) experiencing mortality by day 28. The pendelluft group exhibited significantly higher mortality (19.7% vs. 3.1%, p = 0.035), longer median mechanical ventilation duration [9 (5-15) vs. 7 (5-11) days, p = 0.041] and shorter ventilator-free days at day 28 [18 (4-22) vs. 20 (16-23) days, p = 0.043]. The presence of pendellfut was independently associated with increased mortality at day 28 (OR = 10.50, 95% confidence interval 1.21-90.99, p = 0.033).Conclusions: Pendelluft occurred in 70.4% of difficult-to-wean patients undergoing T piece spontaneous breathing. Pendelluft was associated with worse clinical outcomes, including prolonged mechanical ventilation and increased mortality in this population. Our findings underscore the significance of monitoring pendelluft using EIT during SBT for difficult-to-wean patients.\",\"PeriodicalId\":16123,\"journal\":{\"name\":\"Journal of Intensive Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11194869/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Intensive Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40560-024-00737-z\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40560-024-00737-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

摘要

背景：难以断奶的患者通常被认定为最初的自主呼吸试验（SBT）失败者，其死亡率较高。电阻抗断层扫描（EIT）床旁监测可方便地检测到在 SBT 失败的患者中经常观察到的下垂。本研究旨在探讨 SBT 过程中垂体下垂对难断奶患者的影响：这项回顾性观察研究纳入了接受自主 T 片呼吸的难断奶患者，在此期间收集了 EIT 数据。当 Pendelluft 振幅超过总体潮气阻抗变化的 2.5% 时，即定义为发生 Pendelluft。SBT 期间的生理参数是从 EIT 检查报告单中回顾性获取的。其他临床数据包括机械通气持续时间、重症监护室停留时间、住院时间和 28 天死亡率，均从医院信息系统中每个受试者的病历中获取：在 108 例患者中，有 72 例（70.4%）观察到下垂，其中 16 例（14.8%）在第 28 天死亡。下垂组死亡率明显更高（19.7% 对 3.1%，p = 0.035），中位机械通气时间更长[9 (5-15) 天对 7 (5-11) 天，p = 0.041]，第 28 天无呼吸机天数更短[18 (4-22) 天对 20 (16-23) 天，p = 0.043]。出现垂尾与第28天的死亡率增加独立相关（OR = 10.50，95% 置信区间为1.21-90.99，p = 0.033）：在接受T片自主呼吸的难断奶患者中，70.4%发生了垂头丧气。Pendelluft与较差的临床结果有关，包括延长机械通气时间和增加该人群的死亡率。我们的研究结果表明，在对难断奶患者进行 SBT 时使用 EIT 监测垂尾的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Occurrence of pendelluft during ventilator weaning with T piece correlated with increased mortality in difficult-to-wean patients.

Background: Difficult-to-wean patients, typically identified as those failing the initial spontaneous breathing trial (SBT), face elevated mortality rates. Pendelluft, frequently observed in patients experiencing SBT failure, can be conveniently detected through bedside monitoring with electrical impedance tomography (EIT). This study aimed to explore the impact of pendelluft during SBT on difficult-to-wean patients.

Methods: This retrospective observational study included difficult-to-wean patients undergoing spontaneous T piece breathing, during which EIT data were collected. Pendelluft occurrence was defined when its amplitude exceeded 2.5% of global tidal impedance variation. Physiological parameters during SBT were retrospectively retrieved from the EIT Examination Report Form. Other clinical data including mechanical ventilation duration, length of ICU stay, length of hospital stay, and 28-day mortality were retrieved from patient records in the hospital information system for each subject.

Results: Pendelluft was observed in 72 (70.4%) of the 108 included patients, with 16 (14.8%) experiencing mortality by day 28. The pendelluft group exhibited significantly higher mortality (19.7% vs. 3.1%, p = 0.035), longer median mechanical ventilation duration [9 (5-15) vs. 7 (5-11) days, p = 0.041] and shorter ventilator-free days at day 28 [18 (4-22) vs. 20 (16-23) days, p = 0.043]. The presence of pendellfut was independently associated with increased mortality at day 28 (OR = 10.50, 95% confidence interval 1.21-90.99, p = 0.033).

Conclusions: Pendelluft occurred in 70.4% of difficult-to-wean patients undergoing T piece spontaneous breathing. Pendelluft was associated with worse clinical outcomes, including prolonged mechanical ventilation and increased mortality in this population. Our findings underscore the significance of monitoring pendelluft using EIT during SBT for difficult-to-wean patients.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine

CiteScore

11.90

自引率

1.40%

发文量

审稿时长

15 weeks

期刊介绍： "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.