Clinical analysis of extubation failure in critically ill patients with tracheotomy
10.3969/j.issn.1008-9691.2017.06.011
- VernacularTitle:急危重气管切开患者拔管失败的临床特点分析
- Author:
Junxi NI
1
;
Chenguang FANG
;
Yi LI
Author Information
1. 安徽省池州市人民医院急诊内科
- Keywords:
Tracheotomy;
Acute severe disease;
Extubation failure
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2017;24(6):608-612
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical features of extubation failure in critically ill patients with tracheotomy in order to improve the success rate of tracheal extubation.Methods The clinical data of 52 critically ill patients with tracheotomy admitted to the Department of Emergency Internal Medicine of Chizhou People's Hospital of Anhui Province from January 2014 to January 2017 were retrospectively analyzed; there were 14 cases in failed extubation group (extubation failure: unable to plug the pipe, necessary to be cut or intubated again), and 38 cases were in successful extubation group (success criteria: after trying plugging the pipe for 24 - 48 hours, pulling out sleeving tube of tracheal incision, the incision healed well, within 3 months no dyspnea or pulmonary infection necessary to again performing tracheal intubation or incision). The differences in gender, age, within 3 days before plugging the pipe the consciousness, cough condition, the levels of serum albumin (Alb), serum potassium and serum sodium, brain natriuretic peptide (BNP), hemoglobin (Hb) were compared between the two groups, the clinical characteristics of extubation failure were analyzed, and the descriptions and their numbers for all diseases resulting in extubation failure were carried out.Results The number of conscious patients (24 cases vs. 4 cases), and the number of patients with good cough function (38 cases vs. 3 cases) were obviously more in successful extubation group than those in the failed extubation group, and the levels of serum Alb (g/L: 35.13±3.13 vs. 27.50±5.53), Hb (g/L: 112.18±13.62 vs. 94.14±17.03) in successful extubation group were significantly higher than those in failed extubation group (allP< 0.05). BNP was significantly lower in successful extubation group than that in failed extubation group (ng/L: 344.03±152.85 vs. 5887.80±2695.97,P < 0.05). The common diseases in extubation failure group were as follows: stroke in 7 cases, special severe craniocerebral injury 3 cases, respiratory failure 3 cases, after cardiac pulmonary resuscitation (CPR) operation 1 case.Conclusions The patients are fully assessed before extubation, countermeasures are taken as soon as possible in cases with coma, cough capability poor, hypoproteinemia, heart dysfunction and anemia in order to improve the successful rate of extubation.
