The Effectiveness of Immediate Non-invasive Positive Pressure Ventilation on Decreasing the Re-intubation Rate of Unplanned Extubation

立即性非侵襲性正壓呼吸器的使用降低非計畫性拔管重插管率

10.6314/JIMT.2012.23(5).06

徐歆惠(Hsin-Whae Hsu)；李金杏(Chin-Hsing Li)；陳美珠(Mei-Chu Chen)；簡慧足(Hui-Tsu Chien)；王竹賢(Chu-Hsien Wang)；吳莘華(Shin-Hwar Wu)；洪明煌(Ming-Hwarng Horng)；蕭瑤娟(Yao-Chuan Hsiao)；陳皇吉(Wuang-Chi Chen)；林楷煌(Kai-Huang Lin)

Unplanned extubation ； NIPPV

內科學誌

23卷5期（2012 / 10 / 01）

351 - 359

英文

非計畫性拔管（unplanned extubation, UE）是加護病房常見意外，非計畫性拔管所帶來的併發症，使患者延長加護病房住院天數，甚至增加死亡率。本研究期望了解加護病房患者在非計畫性拔管後，立即性使用非侵襲性正壓呼吸器是否能降低重插管。此回溯性對照研究收集2006年10月至2008年9月為期24個月，成人加護病房年齡大於18歲，符合插管使用呼吸器超過48小時發生非計畫性拔管患者114人，定義為控制組。另於2008年10月至2009年12月，在四個成人加護病房前瞻性收案，當患者發生非計畫性拔管後，依醫囑立即給予非侵襲性正壓呼吸器（NIPPV），使用至少8小時，共收集62人，定義為實驗組。結果顯示實驗組不需重插管的患者有40人（64.5％），控制組54人（47.4％），兩組間的P 值為0.029，顯示立即性給予NIPPV能有效降低非計劃性拔管之重插管率。重插管造成非計劃性拔管病患之二次傷害，增加臨床合併症及死亡率。而立即性給予非侵襲性正壓呼吸器（NIPPV），或許是降低病患重插管率之有效處置之一。

Unplanned extubation, or UE is a common event occurring in the ICU. UE will lead to many serious complications that may extend the duration of stay in the ICU and possibly patient mortality. The historical control study aimed to understand whether re-intubation rate in ICU patients with UE would decrease when given treatment from non-invasive positive pressure ventilation (NIPPV). 24 months retrospective collection of data from October 2006 to September 2008. 114 adult ICU patients, aged 18 years or older and qualified for use of intubation ventilation for more than 48 hours and with UE incidences, are designated as control group. From October 2008 to December of 2009, 62 cases were collected prospectively from 4 adult intensive care units, who developed UE and were given NIPPV immediately for over 8 hours. These cases were designated as the sample group. There were 40 patients from the sample group that did not require re-intubation (64.5%), and 54 patients in control group (47.4%). Statistical analysis revealed that the p value between the two groups was 0.029, showing that immediate administering NIPPV can significantly reduce the re-intubation rate needed for UE. Re-intubation may lead to secondary injury and increase incidence rates of clinical complications and mortality in patients with unplanned extubation. The immediate provision of NIPPV may be an effective measure to decrease the re-intubation needed for patients.