Application of noninvasive ventilation in patients with unplanned extubation in intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

NONG Lingbo , LIU Dongdong , YU Yuheng , LIANG Weibo , CHEN Sibei , XU Yonghao , SANG Ling , LIU Xuesong , YANG Chun , ZHOU Jing , HE Weiqun , LI Yimin ,  LIU Xiaoqing

Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

LIU Xiaoqing, Email: lxq1118@126.com

Keywords：

Unplanned extubation; Noninvasive ventilation; Reintubation; Intensive care unit

DOI：

10.7507/1671-6205.201904019

Video：

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Objective To investigate the application value of noninvasive ventilation (NIV) performed in patients with unplanned extubation (UE) in intensive care unit (ICU).Methods This was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated.Results A total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of (64.2±16.1) years. Out of them, 41 patients (62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients (37.9%) used NIV as the NIV group. The Acute Physiology andChronic Health EvaluationⅡ score of the control group and the NIV group were (18.6±7.7) vs. (14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients (39.0%) vs. 7 patients (28.0%), postoperative respiratory failure 7 patients (17.1%) vs. 8 patients (32.0%), chronic obstructive pulmonary disease 8 patients (19.5%) vs. 6 patients (24.0%), others 5 patients (12.2%) vs. 4 patients (16.0%), heart failure 3 patients (7.3%) vs. 0 patients (0%), nervous system diseases 2 (4.9%) vs. 0 patients (0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were (12.5±19.8) vs (12.7±15.2) d (P=0.966), PaO₂ of the control group and the NIV group before UE was (114.9±37.4) vs. (114.4±46.3)mm Hg (P=0.964), and oxygenation index was (267.1±82.0) vs. (257.4±80.0)mm Hg (P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group (P=0.001). The duration of mechanical ventilation was (23.9±26.0) vs. (21.8±26.0)d (P=0.754), the length of stay in ICU was (34.4±36.6) vs. (28.5±25.8)d (P=0.48). The total mortality rate in this study was 19.7%. The mortality rate in the control group and NIV group were 22.0% and 16.0% (P=0.555).Conclusion Patients with UE in ICU may consider using NIV to avoid reintubation.

Citation： NONG Lingbo, LIU Dongdong, YU Yuheng, LIANG Weibo, CHEN Sibei, XU Yonghao, SANG Ling, LIU Xuesong, YANG Chun, ZHOU Jing, HE Weiqun, LI Yimin, LIU Xiaoqing. Application of noninvasive ventilation in patients with unplanned extubation in intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(6): 527-531. doi: 10.7507/1671-6205.201904019 Copy

1.	Chevron V, Menard JF, Richard JC, et al. Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med, 1998, 26(6): 1049-1053.
2.	de Lassence A, Alberti C, Azoulay E, et al. Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology, 2002, 97(1): 148-156.
3.	Kudela A, Millereux M, Gouezel C, et al. Effect of noninvasive ventilation after unplanned extubation. Respir Care, 2019, 64(3): 248-254.
4.	Xu XP, Zhang XC, Hu SL, et al. Noninvasive ventilation in acute hypoxemic nonhypercapnic respiratory failure: a systematic review and meta-analysis. Crit Care Med, 2017, 45(7): e727-e733.
5.	Jiang JS, Kao SJ, Wang SN. Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning. Respirology, 1999, 4(2): 161-165.
6.	中华医学会重症医学分会. 机械通气临床应用指南(2006). 中华危重病急救医学, 2007, 19(2): 65-72.
7.	Ai ZP, Gao XL, Zhao XL. Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: a systematic review and meta-analysis. Intensive Crit Care Nurs, 2018, 47: 62-68.
8.	Mort TC. Complications of emergency tracheal intubation: immediate airway-related consequences: part Ⅱ. J Intensive Care Med, 2007, 22(4): 208-215.
9.	David-João PG, Guedes MH, Réa-Neto Á, et al. Noninvasive ventilation in acute hypoxemic respiratory failure: a systematic review and meta-analysis. J Crit Care, 2019, 49: 84-91.
10.	Vaschetto R, Longhini F, Persona P, et al. Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Med, 2019, 45(1): 62-71.
11.	Eryüksel E, Karakurt S, Celikel T. Noninvasive positive pressure ventilation in unplanned extubation. Ann Thorac Med, 2009, 4(1): 17-20.
12.	陈荣昌. 如何做好无创正压通气. 中华结核和呼吸杂志, 2008, 31(8): 638-640.
13.	Tindol GA, DiBenedetto RJ, Kosciuk L. Unplanned extubations. Chest, 1994, 105(6): 1804-1807.
14.	Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med, 2000, 161(6): 1912-1916.
15.	Lee JH, Lee HC, Jeon YT, et al. Clinical outcomes after unplanned extubation in a surgical intensive care population. World J Surg, 2014, 38(1): 203-210.
16.	Keenan SP, Powers C, McCormack DG, et al. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA, 2002, 287(24): 3238-3244.

1. Chevron V, Menard JF, Richard JC, et al. Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med, 1998, 26(6): 1049-1053.
2. de Lassence A, Alberti C, Azoulay E, et al. Impact of unplanned extubation and reintubation after weaning on nosocomial pneumonia risk in the intensive care unit: a prospective multicenter study. Anesthesiology, 2002, 97(1): 148-156.
3. Kudela A, Millereux M, Gouezel C, et al. Effect of noninvasive ventilation after unplanned extubation. Respir Care, 2019, 64(3): 248-254.
4. Xu XP, Zhang XC, Hu SL, et al. Noninvasive ventilation in acute hypoxemic nonhypercapnic respiratory failure: a systematic review and meta-analysis. Crit Care Med, 2017, 45(7): e727-e733.
5. Jiang JS, Kao SJ, Wang SN. Effect of early application of biphasic positive airway pressure on the outcome of extubation in ventilator weaning. Respirology, 1999, 4(2): 161-165.
6. 中华医学会重症医学分会. 机械通气临床应用指南(2006). 中华危重病急救医学, 2007, 19(2): 65-72.
7. Ai ZP, Gao XL, Zhao XL. Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: a systematic review and meta-analysis. Intensive Crit Care Nurs, 2018, 47: 62-68.
8. Mort TC. Complications of emergency tracheal intubation: immediate airway-related consequences: part Ⅱ. J Intensive Care Med, 2007, 22(4): 208-215.
9. David-João PG, Guedes MH, Réa-Neto Á, et al. Noninvasive ventilation in acute hypoxemic respiratory failure: a systematic review and meta-analysis. J Crit Care, 2019, 49: 84-91.
10. Vaschetto R, Longhini F, Persona P, et al. Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. Intensive Care Med, 2019, 45(1): 62-71.
11. Eryüksel E, Karakurt S, Celikel T. Noninvasive positive pressure ventilation in unplanned extubation. Ann Thorac Med, 2009, 4(1): 17-20.
12. 陈荣昌. 如何做好无创正压通气. 中华结核和呼吸杂志, 2008, 31(8): 638-640.
13. Tindol GA, DiBenedetto RJ, Kosciuk L. Unplanned extubations. Chest, 1994, 105(6): 1804-1807.
14. Epstein SK, Nevins ML, Chung J. Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med, 2000, 161(6): 1912-1916.
15. Lee JH, Lee HC, Jeon YT, et al. Clinical outcomes after unplanned extubation in a surgical intensive care population. World J Surg, 2014, 38(1): 203-210.
16. Keenan SP, Powers C, McCormack DG, et al. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial. JAMA, 2002, 287(24): 3238-3244.

Chinese Journal of Respiratory and Critical Care Medicine

Application of noninvasive ventilation in patients with unplanned extubation in intensive care unit

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