발관 실패의 위험 인자 및 발관 후 천음과 재삽관의 예측에 있어 Cuff Leak Test의 유용성과 의미 분석
Risk Factors of Extubation Failure and Analysis of Cuff Leak Test as a Predictor for Postextubation Stridor
서지영 (성균관대학교)
경선영 (가천의과학대학교)
고원중 (성균관대학교)
권오정 (성균관대학교)
박정웅 (가천의과학대학교)
이상표 (가천의과학대학교)
정성환 (가천의과학대학교)
정만표 (성균관대학교)
김호중 (성균관대학교)
안창혁 (가천의과학대학교)
함형석 (성균관대학교)
안영미 (성균관대학교)
임시영 (성균관대학교)
- 다운로드 수
- 조회수
Abstract
Background: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. Methods: Thirtyfour consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP).Results: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV (22.5±23.8 vs 233.3±147.1ml, p=0.020) or CLP (6.2±7.3 vs 44.3±24.7%, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low.Conclusion: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.(Tuberc Respir Dis 2006; 61: 34-40)
- keywords
- Extubation failure, Stridor, Cuff leak test., Extubation failure, Stridor, Cuff leak test.
참고문헌
Epstein SK, (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation,
Miller RL, (1996) Association between reduced cuff leak volume and postextubation stridor,
Sandhu RS, (2000) Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation,
Engoren M, (1999) Evaluation of the cuff-leak test in a cardiac surgery population,
Stukel TA, (chest1989;96) Laryngeal complications of prolonged intubation,
Khamiees M, (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial,
Srivastava S,, (1999) Myocardial ischemia and weaning failure in patients with coronary artery disease: an update.,
Namen AM, (2001) Predictors of successful extubation in neurosurgical patients,
DeHaven CB, (1996) Breathing measurement reduces false-negative classification of tachypneic preextubation trial failures,
Rothaar RC, (2003) Extubation failure: magnitude of the problem, impact on outcomes, and prevention,
Daley BJ, (1996) Reintubation as an outcome predictor in trauma patients,
Rady MY, (1999) Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery,
Epstein SK, (1997) Effect of failed extubation on the outcome of mechanical ventilation,
Kollef MH, (1998) The use of continuous i sedation is associated with prolongation of mechanical ventilation,
Epstein SK, (2000) Effect of unplanned extubation on outcome of mechanical ventilation,
Kriner EJ, (2005) The endotracheal tube cuff-leak test as a predictor for postextubation stridor,
de Bast Y, (2002) The cuff leak test to predict failure of tracheal extubation for laryngeal edema,
Jaber S, (2003) Post-extubation stridor in intensive care unit patients risk factors evaluation and importance of the cuff-leak test,
Marik P, (1996) The cuff-leak test as a predictor of postextubation stridor: a prospective study,
Erginel S,, (2005) High body mass index and long duration of intubation increase post-extubation stridor in patients with mechanical ventilation,
Adderley RJ, When to extubate the croup patient,
- 다운로드 수
- 조회수
- 0KCI 피인용수
- 0WOS 피인용수