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B 대학병원 내과 중환자실의 비계획적 발관 발생과 결과에 대한 조사연구
강경자,이희주 한국자료분석학회 2012 Journal of the Korean Data Analysis Society Vol.14 No.3
본 연구는 일개 대학 병원 내과중환자실에서 기관 내 삽관 환자의 비계획적 발관 정도, 환자와 담당 간호사의 상황적 특성을 확인, 발관 된 후 재삽관 정도를 확인하는 서술적 조사연구이다. 연구 기간은 2005부터 2009년까지 5년간, 총 136명의 비계획적 발관 사례를 대상으로 하였다. 연구결과 비계획적 발관률은 6.2%, 간호행위와 연관성이 있는 사고적 발관이 9.6%, 자가발관은 90.4%로 나타났다. 억제대 풀림 또는 부적절로 인한 발생은 55.1%, 비계획적 발관 직전 환자의 호흡기 의존도는 의존도가 낮은 경우가 27.2%, 비계획적 발관 후 재삽관 하지 않은 경우가 39.7%, 밤 근무 때 발생률은 45.6% 등으로 나타났다. 재삽관에 미치는 영향 요인은 의식이 명료하지 않을수록(OR: 2.506)과 밤 근무조일수록(OR: 2.205), 발관이유 중 억제대 부적절인 경우(OR: 0.228) 및 사건, 사고 등 기타원인이 있는 경우(OR: 0.339) 등으로 나타났다. 따라서 억제대 사용 및 적절한 진정제 투여 지침의 개발과 적용, 적기에 계획적 발관을 할 수 있는 지침, 밤근무 간호사의 비예측 발관의 위험요소 주지 및 주의 집중 요구 등이 필요함을 알 수 있었다. The purpose of this study was to identify outcomes and occurrence rate related to unplanned endotracheal extubation (UEE) patients of medical intensive care unit during 5 years from 2005 to 2009. The participants in this study were 136 patients. They experienced UEE in intensive care unit (ICU). We used structured data collection tool and chart reviews were used to collect data for additional data. UEE rate was 6.2%. Alert patients were higher rate among self extubation patients and Not sedated patients were 103 (75.7%). The main reason why it is important that inadequate restraints is applying to patient. Nursing activity is caring other patients at the same time when UEE is occurred. Nurse carrier below 6 month is 22.8%. Especially, critical time is from 10:30 pm to 4 am during night duty. Reintubation patient is 60.3%, the others is not needed reintubation after UEE. Mental state, more not alert (OR: 2.506), night duty (OR: 2.205), inappropriate restraint (OR: 0.228) & other accidents (OR: 0.339) were significantly related to reintubation. The results of this study indicate that is needed a prevention program for unplanned extubation. Adequate intervention should be served for intubated patients in ICU.
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P-22 Impact of limb weakness on re-intubation after planned extubation in medical patients
정병호,남지명,고명균,정치량,서지영,전경만 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Objectives: The objective of this cohort study was to evaluate the association between limb muscle weakness assessed by Medical Research Council (MRC) scale on the day of the planned extubation and re-intubation rate in a medical intensive care unit (ICU). Methods: We retrospectively analyzed all consecutive medical ICU patients who were mechanically ventilated for more than 24 hours and were weaned according to the protocol between January 2012 and December 2013. Results: Of 377 consecutive patients, 58 (15.4%) patients required re-intubation within the 48 hours following planned extubation. MRC scale of four limbs was lower in patients with re-intubation (median 14 points, IQR 10-16 points) than those without re-intubation (median 16 points, IQR 12-18 points; P = 0.005). In addition, re-intubation rates decreased significantly with increasing quartiles of MRC scales (P for trend < 0.001). In multivariable analysis, MRC scale was independently associated with re-intubation (adjusted OR 0.911, 95% CI 0.835-0.994, P = 0.037 for increasing one point of MRC scale). In addition, MRC scale ≤ 10 points for four limbs had an adjusted OR of 2.276 (95% CI 1.074-4.825, P = 0.032) to the probability of re-intubation within 48 h after planned extubation after adjusting for potential confounding factors. Conclusions: Limb muscle weakness assessed on the day of extubation was found to be independently associated with higher re-intubation rate within 48 h following planned extubation in the medical ICU having a protocol-based weaning program.
KCI
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