延长机械通气患者高、低快速浅呼吸指数与脱机的比较

Journal of the Bangladesh Society of Anaesthesiologists Pub Date : 2020-01-31 DOI:10.3329/jbsa.v33i1.67476

Md. Sirajul Islam, Md Ali Haider, Uzzwal Kumar Mallick, M. Asaduzzaman, Md Gisan Hossain, Kazi Eshika Raka, Mohammad Safayat Kamal

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引用次数: 0

摘要

背景:快速浅呼吸指数对于长时间机械通气患者的脱机至关重要。目的:本研究的目的是比较长时间机械通气患者高、低快速浅呼吸指数与脱机。方法:本队列研究于2014年1月至2015年12月在孟加拉国达卡达卡医学院医院麻醉、疼痛缓解和重症监护室进行，为期2年。本研究纳入18 ~ 60岁ICU机械通气时间超过48小时的患者。标准的脱机标准被认为是解决呼吸衰竭的主要原因、警觉状态、合作、对命令的反应和格拉斯哥昏迷评分(GCS)。呼吸机的初始和日常设置以及患者的脱机决定由ICU顾问做出。然后测量RSBI。断奶的决定不受RSBI的影响。测量RSBI后，患者脱离机械呼吸机，给予t片试验(1 ~ 4小时)，最后根据icu会诊医师建议拔管观察48小时。将患者分为低RSBI≥105breath/min/L组和高RSBI≥105breath/min/L组。这些患者在ICU和HDU随访48小时。结果:本研究共纳入117例患者。年龄18 ~ 60岁，平均35.42±13.66岁。低RSBI组平均机械通气9.6±6.4 d，高RSBI组平均机械通气8.6±4.5 d (p>0.05)。记录RSBI与患者成功断奶的关系。低RSBI组患者持续拔管成功率94.6%，高RSBI组患者持续拔管成功率76.0%。低RSBI组患者的成功率显著高于对照组(p=0.001)。测量RSBI与患者脱机失败之间的关系。高RSBI组失败6例(24.0%)，成功19例(76.0%)。低RSBI组失败5例(5.4%)，成功87例(94.6%)(p=0.011)。结论:结论快速浅呼吸指数高低与延长机械通气患者脱机有显著相关性。JBSA 2020;33 (1): 10 - 15

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Comparison between High and Low Rapid Shallow Breathing Indexes with Weaning of Patients in Prolonged Mechanical Ventilation

Background: The rapid shallow breathing indexe is crucial considering the weaning of patients inprolonged mechanical ventilation. Objective: The purpose of the present study was to compare the high and low rapid shallow breathingindexes with weaning of patients in prolonged mechanical ventilation. Methodology: This cohort study was conducted in the Department of Anesthesia, Pain Palliative &Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 toDecember 2015 for a period of two (02) years. Patients of ICU on mechanical ventilation more than 48hours with the age of 18 to 60 years were included in this study. Standard weaning criteria was consideredas resolution of the primary cause of respiratory failure, state of alertness, cooperation, response tocommands and Glasgow coma scale (GCS) scores ³9. Primary and daily setting of ventilators and thedecision to weaning of the patient was made by the ICU consultants. RSBI was then measured. Thedecision of weaning was not influenced by the RSBI. After measuring RSBI, patients was separatedfrom mechanical ventilator and given T-piece trial (1 to 4 hours) and finally extubated as per advice ofICU consultant and observed for 48 hours. The patients were divided in two groups low RSBI £105breath/min/L and high RSBI >105breath/min/L. These patients were prospectively followed up to 48hours in ICU and HDU. Result: A total of 117 patients were included in this study. The mean age was found 35.42±13.66 yearswith range from 18 to 60 years. The mean mechanical ventilation was found 9.6±6.4 days in low RSBIgroup and 8.6±4.5 days in high RSBI group (p>0.05). The association between RSBI and success inweaning of the patients was recorded. In low RSBI group 94.6% patient’s sustained extubation (success)and high RSBI group 76.0% patients’ sustained extubation. Success was significantly higher in patientswith low RSBI group (p=0.001). The association between RSBI and weaning failure of the patients wasmeasured. In high RSBI group failure was 6(24.0%) and success was 19(76.0%). On the other hand inlow RSBI group failure was found 5(5.4%) and success was 87(94.6%) (p=0.011). Conclusion: In conclusion significant association is found between high and low rapid shallow breathingindexes with weaning of patients in prolonged mechanical ventilation. JBSA 2020; 33(1): 10-15

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Journal of the Bangladesh Society of Anaesthesiologists

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