論文No4058
Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity
A Retrospective Analysis of a Multicenter Prospective Observational Study
Audrey De Jong,Mathieu Capdevila,Yassir Aarab,...Elie Azoulay,Samir Jaberfor the FREE-REA Study Group
CHEST, Volume 167, Issue 1, p139-151, January 2025.
要約
この研究は、重症患者における抜管(人工呼吸器を外すこと)の成功率に、肥満がどのように影響するかを調べたものです。
具体的には、肥満の患者とそうでない患者で、抜管後に再び人工呼吸器が必要になる「抜管不成功」が起こる割合や、その原因となるリスク因子を比較しました。
研究の結果、肥満の患者は非肥満の患者と比べて、抜管不成功の割合に大きな差は見られませんでした。
しかし、肥満の患者は非侵襲的換気や理学療法をより多く受けており、抜管不成功のリスク因子も異なることがわかりました。
具体的には、肥満の患者では女性や抜管前の興奮が、非肥満の患者では強い咳の欠如や人工呼吸器を付けていた期間が、それぞれ抜管不成功のリスクを高める因子として挙げられました。
Take Home Message
この研究から得られる重要な点は、以下の通りです。
肥満は抜管不成功の直接的な原因ではない可能性がある: 肥満の患者でも、適切なケア(非侵襲的換気や理学療法など)を行うことで、非肥満の患者と同様の抜管成功率が期待できる可能性があります。
肥満の患者は、性別や精神状態など、他の要因に注意する必要がある: 肥満の患者では、非肥満の患者とは異なるリスク因子に注意することで、抜管不成功を予防できる可能性があります。
抜管前の状態が重要: 強い咳がない、人工呼吸器を長くつけていたなどの状態は、抜管不成功のリスクを高めるため、これらの状態を改善するための介入が重要です。
つまり、肥満の患者であっても、適切なケアと個々の患者に合わせた対策を行うことで、抜管の成功率を向上させることが期待できるということです。
Background
To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.
Research Question
What are the incidence and risk factors of extubation failure in patients with and without obesity?
Study Design and Methods
In the prospective multicenter observational Practices and Risk Factors for Weaning and Extubation Airway Failure in Adult Intensive Care Unit: A Multicenter Trial (FREEREA) study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure using first a logistic regression model and second a decision tree analysis.
Results
Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.
Interpretation
Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rates of extubation failure among patients with and without obesity.