Cardiac Dysfunction Is Not Associated with Increased Reintubation Rate in Patients Treated with Post-extubation High-Flow Nasal Cannula

Lee Young Seok,Choi Juwhan,Oh Jee Youn,민경훈,Hur Gyu Young,이승룡,Shim Jae Jeong,심재겸 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.4

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period.Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation.Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292).Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

Analysis of the Risk Factors Associated with Prolonged Intubation or Reintubation after Anterior Cervical Spine Surgery

Moinay Kim,임승철,노성우,전상룡 대한의학회 2018 Journal of Korean medical science Vol.33 No.17

Background: Standardized postoperative airway management is essential for patients undergoing anterior cervical spine surgery (ACSS). The paucity of clinical series evaluating these airway complications after ACSS has been resulted in a significant limitation in statistical analyses. Methods: A retrospective cohort study was performed regarding airway distress (intubation for more than 24 hours or unplanned reintubation within 7 days of operation) developed after ACSS. If prevertebral soft tissue swelling was evident after the operation, patients were managed with prolonged intubation (longer than 24 hours). Preoperative and intraoperative patient data, and postoperative outcome (time to extubation and reintubation) were analyzed. Results: Between 2008 and 2016, a total of 400 ACSS were performed. Of them, 389 patients (97.25%) extubated within 24 hours of surgery without airway complication, but 11 patients (2.75%) showed postoperative airway compromise; 7 patients (1.75%) needed prolonged intubation, while 4 patients (1.00%) required unplanned reintubation. The mean time for extubation were 2.75 hours (range: 0–23 hours) and 50.55 hours (range: 0–250 hours), respectively. Age (P = 0.015), diabetes mellitus (P = 0.003), operative time longer than 5 hours (P = 0.048), and estimated blood loss (EBL) greater than 300 mL (P = 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation. Conclusion: In ACSS, postoperative airway compromise is related to both patients and operative factors. We recommend a prolonged intubation for patients who are exposed to these risk factors to perform a safe and effective extubation.

Analysis of the Risk Factors Associated with Prolonged Intubation or Reintubation after Anterior Cervical Spine Surgery

Kim, Moinay,Rhim, Seung Chul,Roh, Sung Woo,Jeon, Sang Ryong KOREAN ACADEMY OF MEDICAL SCIENCE 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.17

<P><B>Background</B></P><P>Standardized postoperative airway management is essential for patients undergoing anterior cervical spine surgery (ACSS). The paucity of clinical series evaluating these airway complications after ACSS has been resulted in a significant limitation in statistical analyses.</P><P><B>Methods</B></P><P>A retrospective cohort study was performed regarding airway distress (intubation for more than 24 hours or unplanned reintubation within 7 days of operation) developed after ACSS. If prevertebral soft tissue swelling was evident after the operation, patients were managed with prolonged intubation (longer than 24 hours). Preoperative and intraoperative patient data, and postoperative outcome (time to extubation and reintubation) were analyzed.</P><P><B>Results</B></P><P>Between 2008 and 2016, a total of 400 ACSS were performed. Of them, 389 patients (97.25%) extubated within 24 hours of surgery without airway complication, but 11 patients (2.75%) showed postoperative airway compromise; 7 patients (1.75%) needed prolonged intubation, while 4 patients (1.00%) required unplanned reintubation. The mean time for extubation were 2.75 hours (range: 0–23 hours) and 50.55 hours (range: 0–250 hours), respectively. Age (<I>P</I> = 0.015), diabetes mellitus (<I>P</I> = 0.003), operative time longer than 5 hours (<I>P</I> = 0.048), and estimated blood loss (EBL) greater than 300 mL (<I>P</I> = 0.042) were associated with prolonged intubation or reintubation. In prolonged intubation group, all patients showed no airway distress after extubation.</P><P><B>Conclusion</B></P><P>In ACSS, postoperative airway compromise is related to both patients and operative factors. We recommend a prolonged intubation for patients who are exposed to these risk factors to perform a safe and effective extubation.</P>

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.

Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit

A Lan Lee,Chi Ryang Chung,Jeong Hoon Yang,Kyeongman Jeon,박치민,Gee Young Suh 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.3

Background: Unplanned extubation (UE) of patients requiring mechanical ventilation in an intensive care unit (ICU) is associated with poor outcomes for patients and organizations. This study was conducted to assess the clinical features of patients who experienced UE and to determine the risk factors affecting reintubation after UE in an ICU. Methods: Among all adult patients admitted to the ICU in our institution who required mechanical ventilation between January 2011 and December 2013, those in whom UE was noted were included in the study. Data were categorized according to noninvasive or invasive management after UE. Results: The rate of UE was 0.78% (the number of UEs per 100 days of mechanical ventilation). The incidence of self-extubation was 97.2%, while extubation was accidental in the remaining patients. Two cases of cardiac arrest combined with respiratory arrest after UE were noted. Of the 214 incidents, 54.7% required invasive management after UE. Long duration of mechanical ventilation (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.32-1.75; p = 0.000) and high ICU mortality (OR 4.39; 95% CI 1.33-14.50; p = 0.015) showed the most significant association with invasive management after UE. In multivariate analysis, younger age (OR 0.96; 95% CI 0.93-0.99; p = 0.005), medical patients (OR 4.36; 95% CI 1.95-9.75; p = 0.000), use of sedative medication (OR 4.95; 95% CI 1.97-12.41; p = 0.001), large amount of secretion (OR 2.66; 95% CI 1.01-7.02; p = 0.049), and low PaO2/FiO2 ratio (OR 0.99; 95% CI 0.98-0.99; p = 0.000) were independent risk factors of invasive management after UE. Conclusions: To prevent unfavorable clinical outcomes, close attention and proper ventilatory support are required for patients with risk factors who require invasive management after UE.