Application of CLT guiding offline extubation in patient with tracheal intubation of mechanical ventilation / 中国医学装备

ABSTRACT

Objective: To explore the application of the cuff-leak test(CLT)guiding offline extubation in patients with tracheal intubation of mechanical ventilation.Methods: 64 patients with tracheal intubation who underwent mechanical ventilation were divided into CLT-negative group(47 cases)and CLT-positive group(17 cases)according to leakage situation of CLT.The CLT guiding offline extubation were adopted in the study and some basic situations,such as body mass index(BMI),APACHE-Ⅱ and so on,of the two groups were compared.And the relative situation of intubation,blood gas analysis index,vital signs,the occurrence rate of upper airway obstruction(UAO)post removing intubation and re-intubation rate between the two groups also were compared,and then the risk factors of influencing UAO were further analyzed.Results: The BMI of CLT-negative group was significantly smaller than that of CLT-positive group(t=2.44,P＜0.05).The occurrence rate of UAO and re-intubation rate of CLT-negative group(6.38％and 2.13％)were significantly lower than that of CLT-positive group(35.29％and 17.65％)(x2=8.63,x2=5.13,P＜0.05),respectively.The differences of BMI,APACHE-Ⅱ scores,intubation time,air sac pressure,PaO2and SpO2between patients with UAO and patients without UAO were significant(t=5.63,t=2.65,t=4.27,t=3.35,t=2.37,t=2.66,P＜0.05).The results of Logistic regression analysis showed that the BMI,APACHEⅡ score,intubation time,air sac pressure were independent risk factors for occurring UAO post extubation.Conclusion: The CLT guiding offline extubation in patient with tracheal intubation of mechanical ventilation can effectively reduce the re-intubation rate.For these patients with obesity,high APACHE-Ⅱ score,long intubation time and big air sac pressure,the risk of occurring UAO is higher.Therefore,the number of intubation pre extubation should be reduced for them,and their physiological status should be comprehensively assessed so as to decrease the occurrence rate of UAO.