Objective To assess the risk factors associated with extubation failure in patients who had successfully passed a spontaneous breathing trial.Methods Patients receiving invasive mechanical ventilation for over 48 h were enrolled in the study，they were admitted into Emergency ICU of Zhongshan Hospital during May 2006 and Oct.2007.A spontaneous breathing trial was conducted by a pressure support of 7 cm H2O for 30 min.Clinical data were prospectively recorded for the patient receiving full ventilatory support before and after the spontaneous breathing trial.Regarding the extubation outcome，patients were divived into extubation success group and extubation failure group.Results A total of 58 patients with a mean（±SD） age of 69.4±12.7 years passed spontaneous breathing trial and were extubated.Extubation failure occurred in 11 patients（19%）.The univariate analysis indicated the following associations with extubation failure：elderly patients（78.1±7.9 years vs 67.4±15.1years，Plt;0.05），higher rapid shallow breathing index（RSBI） value（83±12 breaths·min-1·L-1 vs 68±19 breaths·min-1·L-1，Plt;0.05）and excessive respiratory tract secretions（54.5％ vs 21.3％，Plt;0.05）.Conclusion Among routinely measured clinical variables，elderly patients，higher RSBI value and amount of respiratory tract secretions were the valuable index for predicting extubation failure despite a successful spontaneous breathing trial.
Objective To determine the usefulness of serial measurements of the rapid shallow breathing index ( f/VT , RSBI) as a predictor for successfully weaning of patients undergoing prolonged mechanical ventilation ( gt; 72 hours) . Methods 76 mechanically ventilated patients were prospectively analyzed. 120-min spontaneous breathing trial was conducted after the patients having fullfiled the traditional weaning criteria, and RSBI were continuously monitored by the ventilator at five time points ( 5, 15, 30,60, and 120 min) . A repeated measure of general linear model in SPSS 15.0 was conducted to analyze the data. Results 62 patients completed 120-minute spontaneous breath trial and in which 20 patients failed weaning. There was no significant difference of RSBI at five time points during weaning ( P gt;0. 05) . But thevariation trends of RSBI during weaning time were significant different between the successful weaning patients and the failed weaning patients ( P lt; 0. 05) . Conclusions In patients undergoing prolonged mechanical ventilation, the variation trend of RSBI is more valuable than single RSBI in the prediction ofsuccessful weaning.
【摘要】 目的 通过观察单肺通气患者术中氧合指数（oxygenation index，OI）、呼吸指数（respiratory index，RI）及动态肺顺应性（dynamic lung compliance，Cdyn）的变化，探讨高渗氯化钠溶液对术中单肺通气患者的肺保护作用。 方法 选择2009年12月-2011年2月完成的美国麻醉师协会分级为Ⅰ~Ⅲ级，心肺功能筛查、血常规、肝肾功能及凝血功能无明显异常，拟在全麻双腔气管插管下行开胸手术，术中需行单肺通气患者60例，随机分为高渗氯化钠组（A组）和对照组（B组），每组30例。A组在开始单肺通气后30 min快速输注7.5%高渗氯化钠溶液2 mL/kg，15 min内输注完毕，B组输注等量生理盐水，分别记录输注前（T1）、输注完毕时（T2）、输注后30 min（T3）、输注后1 h（T4）的OI、RI及Cdyn变化，并比较两组各时间点生命体征变化。 结果 两组患者OI、RI及Cdyn在T1、T2时差异无统计学意义（Pgt;0.05）；两组患者不同时间点平均动脉压、心率、脉搏血氧饱和度、中心静脉压、呼气末CO2分压比较差异无统计学意义（Pgt;0.05）；A组患者在T3、T4时的OI和Cdyn较B组明显升高，RI明显降低（Plt;0.05）；且A组患者在T3、T4时的OI和Cdyn较T1时明显增高，RI明显降低（Plt;0.05）。 结论 高渗氯化钠溶液能改善术中单肺通气患者的OI、RI及Cdyn，对肺功能有一定的保护作用。【Abstract】 Objective To observe the oxygenation index (OI), respiratory index (RI) and dynamic lung compliance (Cdyn) changes of the patients with one-lung ventilation, in order to determine if hypertonic saline has lung protective effects. Methods Sixty ASA Ⅰ-Ⅲ patients who needed one-lung ventilation during thoracotomy under general anesthesia with double-lunmen endotracheal tubes were chosen to be the study subjects. No obvious abnormalities were detected by cardiopulmonary function screening, blood test, hepatorenal function and blood coagulation examinations in these patients. They were randomly divided into hypertonic saline group (group A) and control group (group B) with 30 patients in each group. For patients in group A, 30 minutes after one-lung ventilation, infusion of 7.5% hypertonic saline solution at 2 mL/kg was carried out and completed in 15 minutes. For patients in group B, the same amount of saline solution was infused. We recorded OI, RI and Cdyn changes before the infusion (T1), on the completion of the infusion (T2), 30 minutes after the infusion (T3), and 1 hour after the infusion (T4). The changes of vital signs in patients of the two groups were compared. Results OI, RI and Cdyn were not significant different between the two groups at T1 and T2 (Pgt;0.05). Mean arterial pressure (MAP), heart rate (HR), SpO2, central venous pressure (CVP), and PetCO2 were not significant different between the two groups at all time points (Pgt;0.05). OI and Cdyn of group A patients were significantly higher than those of group B, while RI was significantly lower at T3 and T4 (Plt;0.05). Cdyn and OI of group A patients at T3 and T4 were significantly higher when compared with T1, and RI was significantly lower (Plt;0.05). Conclusion Hypertonic saline has the lung protection effect in patients with one-lung ventilation by improving OI, RI and Cdyn.
ObjectiveTo evaluate the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) for weaning outcome prediction.MethodsThis was a prospective observation study. Respiratory rate (RR) and tidal volume (Vt) were recorded at the end of spontaneous breathing trial, and both M-Mode and B-Mode ultrasonography were used to assess the right diaphragmatic displacement (DD). In parallel, outcome of the weaning attempt, length of mechanical ventilation, length of stay in intensive care unit (ICU) and mortality of ICU were recorded. According to the weaning outcome, the patients were grouped into the successful group and the failed group. The receiver operator characteristic (ROC) curve was used to assess the value of rapid shallow breathing index (RSBI, RR/Vt) and D-RSBI (RR/DD) in predicting weaning failure for ICU patients with mechanical ventilation.ResultsA total of 110 patients recruited in this study. Of them, 73 (66.4%) patients were successfully liberated from mechanical ventilation, and 37 patients failed (33.6%) weaning procedure. The RSBI and D-RSBI of the patients in the failed group were higher than those in the success weaning group (P<0.01). The area under the ROC curves of RSBI and D-RSBI for predicting weaning failure was 0.78 (95% confidence interval 0.69 - 0.87), 0.91 (95% confidence interval 0.85 - 0.97), respectively, a cutoff of RSBI>69 breaths/(L·min) yielded sensitivity of 55% and specificity of 89%, and a cutoff of D-RSBI>1.5 breaths/(min·mm) yielded sensitivity of 87% and specificity of 80%.ConclusionD-RSBI is more accurate than traditional RSBI in predicting the weaning outcome.