A study for predictors of extubation success in patients with neuropathic respiratory failure

• Main Authors: Yao-Yi Liu, 劉耀義
• Other Authors: Juei-Tang Cheng
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/8pk326

碩士 === 長榮大學 === 醫學研究所 === 103 === Respiratory failure is a problem which needs medical team members to deal with when treating critically ill patients. Because of the influences of neurological diseases or symptoms, physicians facing specific patients with type II respiratory failure (those patients are defined as “patients with neuropathic respiratory failure” in this study) have to think more about the impact of treatments on patients’ circulatory and neurological systems; under the circumstances mentioned above, it turns to be difficult to cure those patients. The aim of this study was to find out the predictors which might predict the extubation success in patients with neuropathic respiratory failure after they were intubated. Participants studied in this study were patients with neuropathic respiratory failure, being intubated in a medical center and attempted to be successfully extubated after planned weaning for 120 hours. The descriptive statistics, chi-squared tests and t tests for independent samples were conducted for describing the distribution of the data of the participants, comparing data of variables of patients being successfully extubated and of patients failing to be extubated to understand if two groups of data of variables were statistically different. Those variables whose data were statistically different between patients being successfully extubated and of patients failing to be extubated were included in the logistic regressional analysis to understand if there was a causal relationship between those variables and extubation success. The results showed that patients being older than 65 year-old, with hypoventilation, post-operation, type of weaning, accepting simple weaning, with tumors, being transferred to respiratory care center (RCC), being transferred to RCW (or hospice), with tracheostomy retainer (TR), with excessive upper airway secretions, with oxygenation failure, with encephalopathy, and being reintubated were statistically associated with extubation success. Variables including age, total hours for intubation, length of stay in intensive care unit (ICU), length of stay in RCC, length of stay in hospital, expenditure in hospital, respiratory rate (RR), RR after being extubated, pH of arterious blood after being extubated, PaCO2 after being extubated, oxygenation index after being extubated, APACHE II score, TISS score, GCS score, measurement of hemoglobin, hematocrit and numbers of comorbidities were statistically different between patients being successfully extubated and patients failing to be extubated. The result of multivariate logistic regression showed that the odds of extubation success would decrease to 70.9% while patients stayed in ICU for one more day each time. It was suggested that the longer the patients had stayed in ICUs, the worse their physical conditions were and the patients’ worse physical conditions might influence their respiratory functions negatively, increasing the risk of extubation failure.