Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28671
タイトル
Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study
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内容記述

Abstract
Background:

Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion. Nevertheless, it is not used commonly in the weaning and extubation process. In this study, we investigated whether lung-thorax compliance is a good index of extubation failure in adults even when patients pass a spontaneous breathing trial.
Methods:

In a single-center, retrospective cohort study, patients over 18 years of age were mechanically ventilated, weaned with proportional assist ventilation, and underwent a spontaneous breathing trial process in surgical intensive care units of Kagawa University Hospital from July 2014 to June 2016. Extubation failure was the outcome measure of the study. We defined extubation failures as when patients were reintubated or underwent non-invasive positive-pressure ventilation within 24 h after extubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the clinical involvement of several parameters. The area under the curve (AUC) was calculated to assess the discriminative power of the parameters.
Results:

We analyzed 173 patients and compared the success and failure groups. Most patients (162, 93.6%) were extubated successfully, and extubation failed in 11 patients (6.4%). The averages of lung-thorax compliance values in the success and failure groups were 71.9 ± 23.0 and 43.3 ± 14.6 mL/cmH2O, respectively, and were significantly different (p < 0.0001). In the ROC curve analysis, the AUC was highest for lung-thorax compliance (0.862), followed by the respiratory rate (0.821), rapid shallow breathing index (0.781), Acute Physiology and Chronic Health Evaluation II score (0.72), heart rate (0.715), and tidal volume (0.695).
Conclusions:

Lung-thorax compliance measured during a spontaneous breathing trial is a potential indicator of extubation failure in postoperative patients.

KEYWORDS:

Extubation failure; Lung and thorax compliance; Proportional assist ventilation; Spontaneous breathing trial

(医博甲707)

著者
著者 岡部 悠吾
著者(ヨミ) オカベ ユウゴ
著者(別表記) Okabe Yugo
掲載誌
Journal of Intensive Care
掲載誌(別表記)
J Intensive Care.
6
開始ページ
44
終了ページ
52
出版者
Japanese Society of Intensive Care Medicine
日本集中医療医学会
BMC (part of Springer Nature)
出版者(別表記)
日本集中医療医学会
出版年月日
2018-07-31
ISSN
2052-0492
PMID
30083347
DOI
10.1186/s40560-018-0313-9
資料タイプ
学位論文
言語
英語
関連情報
出版社版DOIリンク(URL): https://doi.org/10.1186/s40560-018-0313-9
PMCID: PMC6069862
関連情報URL
https://doi.org/10.1186/s40560-018-0313-9
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069862/
関連情報(isVersionOf)
Publisher's Version
権利関係
Copyright © The Author(s). 2018
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
DOI: https://doi.org/10.1186/s40560-018-0313-9
博士論文(全文を含む)
学位授与番号
博甲第707号
学位授与年月日
2019-03-24
学位名
博士(医学)
学位授与機関
香川大学
区分
香川大学
Copyright (C) 2009 Kagawa University All rights reserved.