神经重症患者脱机失败危险因素及风险预测模型临床应用的研究进展

doi:10.3761/j.issn.2096-7446.2024.12.014

摘要/Abstract

摘要： 脱机失败是指患者在脱离呼吸机后,无法维持自主呼吸,需要重新连接呼吸机。神经重症患者因疾病特殊性,呼吸支持治疗中有较大的脱机失败风险。该文综述了神经重症患者脱机失败的危险因素以及脱机失败预测模型临床应用相关研究,为临床医护人员针对性预防危险因素,精准预测脱机失败风险提供参考。

关键词: 神经重症, 脱机失败, 预测模型, 危险因素, 综述

Abstract: The failure of the extubation failure means that the patient cannot maintain the autonomous breathing after leaving the ventilator,and the ventilator needs to be re-connected. Due to the particularity of the disease,patients have a greater risk of extubation failure in breathing support treatment. This article summarizes the risk factors of neurological critically ill patients‘ extubation failure,and the study of the predictive model of the extubation failure,which provides technical support for clinical medical staff for targeted prevention of risk factors and accurate prediction of extubation failure risk.

Key words: Neurotic Symptoms, Extubation Failure, Predictive Model, Risk Factor, Review

王海燕, 祁学峰, 姚梅琪, 兰美娟. 神经重症患者脱机失败危险因素及风险预测模型临床应用的研究进展[J]. 中华急危重症护理杂志, 2024, 5(12): 1138-1142.

WANG Haiyan, QI Xuefeng, YAO Meiqi, LAN Meijuan. Research progress on risk factors of extubation failure and clinical application of risk prediction model in patients with severe neurological diseases[J]. Chinese Journal of Emergency and Critical Care Nursing, 2024, 5(12): 1138-1142.

参考文献

[1] 徐晓敏. 神经重症患者直系陪护家属症状负担及其影响因素研究[D]. 济南:山东大学,2022.
Xu XM.Study on symptom burden and influencing factors of direct accompanying family members of patients with severe neurological diseases[D]. Jinan:SDU,2022.
[2] Jaber S,Quintard H,Cinotti R,et al.Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit:a multicenter observational study of 1514 extubation procedures[J]. Crit Care,2018,22(1):236.
[3] Godoy DA,Rovegno M,Jibaja M.Extubation after acute brain injury:an unsolved dilemma!![J]. Neurocrit Care,2023,9(5):1.
[4] Robba C,Poole D,McNett M,et al. Mechanical ventilation in patients with acute brain injury:recommendations of the European Society of Intensive Care Medicine consensus[J]. Intensive Care Med,2020,46(12):2397-2410.
[5] Le Neindre A,Philippart F,Luperto M,et al.Diagnostic accura-cy of diaphragm ultrasound to predict weaning outcome:a sys-tematic review and meta-analysis[J]. Int J Nurs Stud,2021, 117:103890.
[6] Suntrup-Krueger S,Schmidt S,Warnecke T,et al.Extubation readiness in critically ill stroke patients[J]. Stroke,2019,50(8):1981-1988.
[7] Rabinstein AA,Cinotti R,Bösel J.Liberation from mechanical ventilation and tracheostomy practice in traumatic brain injury[J]. Neurocrit Care,2023,38(2):439-446.
[8] Carrera M,Urrutia JG,Ardariz CB,et al.Maximal expiratory pressure compared with maximal expiratory pressure during induced cough as a predictor of extubation failure[J]. Crit Care Sci,2023,35(1):37-43.
[9] 徐珊珊,张琳琳,周建新. 神经重症患者脱机拔管研究进展[J]. 中华危重病急救医学,2022,34(9):1004-1008.
Xu SS,Zhang LL,Zhou JX.Weaning and extubation in neuro-critical care patients[J]. Chin Crit Care Med,2022,34(9):1004-1008.
[10] Routsi C,Stanopoulos I,Kokkoris S,et al.Weaning failure of cardiovascular origin:how to suspect,detect and treat-a review of the literature[J]. Ann Intensive Care,2019,9(1):6.
[11] Akella P,Voigt LP,Chawla S.To wean or not to wean:a practical patient focused guide to ventilator weaning[J]. J In-tensive Care Med,2022,37(11):1417-1425.
[12] Krishnamoorthy V,Hough CL,Vavilala MS,et al.Tracheos-tomy after severe acute brain injury:trends and variability in the USA[J]. Neurocrit Care,2019,30(3):546-554.
[13] Videtta W,Vallejos J,Roda G,et al.Predictors of successful extubation in neurocritical care patients[J]. Acta Neurochir Suppl,2021,131:91-93.
[14] Tanwar G,Singh U,Kundra S,et al.Evaluation of airway care score as a criterion for extubation in patients admitted in neurosurgery intensive care unit[J]. J Anaesthesiol Clin Phar-macol,2019,35(1):85-91.
[15] Steidl C,Bösel J,Suntrup-Krueger S,et al.Tracheostomy,extu-bation,reintubation:airway management decisions in intubated stroke patients[J]. Cerebrovasc Dis,2017,44(1/2):1-9.
[16] Burns K,Rizvi L,Cook D J,et al.Ventilator weaning and discontinuation practices for critically ill patients[J]. JAMA,2021,325(12):1173-1184.
[17] Godet T,Chabanne R,Marin J,et al.Extubation failure in brain-injured patients:risk factors and development of a prediction score in a preliminary prospective cohort study[J]. Anesthesiology,2017,126(1):104-114.
[18] Fossat G,Desmalles E,Courtes L,et al.Cough peak flow assessment without disconnection from the ICU ventilator in mechanically ventilated patients[J]. Respir Care,2023,68(4):470-477.
[19] Dos Reis HFC,Gomes-Neto M,Almeida MLO,et al.Develop-ment of a risk score to predict extubation failure in patients with traumatic brain injury[J]. J Crit Care,2017,42:218-222.
[20] Da SA,Novais M,Neto M G,et al.Predictors of extubation failure in neurocritical patients:A systematic review[J]. Aust Crit Care,2023,36(2):285-291.
[24] Xu SS,Tian Y,Ma YJ,et al.Development of a prediction score for evaluation of extubation readiness in neurosurgical patients with mechanical ventilation[J]. Anesthesiology,2023, 139(5):614-627.
[25] Asehnoune K,Seguin P,Lasocki S,et al.Extubation success prediction in a multicentric cohort of patients with severe brain injury[J]. Anesthesiology,2017,127(2):338-346.
[26] Cinotti R,Mijangos JC,Pelosi P,et al.Extubation in neuroc-ritical care patients:the ENIO international prospective study[J]. Intensive Care Med,2022,48(11):1539-1550.
[24] 杨晓文,童孜蓉,吴娟,等. 神经外科重症机械通气患者脱机失败预测模型的构建[J]. 军事护理,2023,40(6):9-12.
Yang XW,Tong ZR,Wu J,et al.Development of prediction model of weaning failure in neurosurgical patients with severe mechanical ventilation[J]. Mil Nurs,2023,40(6):9-12.