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排序方式: 共有613条查询结果,搜索用时 15 毫秒
1.
Elizabeth D. Krebs Robert B. Hawkins J. Hunter Mehaffey Clifford E. Fonner Alan M. Speir Mohammed A. Quader Jeffrey B. Rich Leora T. Yarboro Nicholas R. Teman Gorav Ailawadi 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1533-1542.e2
Objectives
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.Methods
Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.Results
A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.Conclusions
Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight. 相似文献2.
A. Guerrero Gómez N. González Jaramillo J.A. Castro Pérez 《Revista espa?ola de anestesiología y reanimación》2019,66(1):10-17
Introduction
The fast track / ultra-fast-track protocols are techniques used to optimise the patient care process and a quick recovery after cardiac surgery. They are one of the mainstays of efficient practice. With their use, the length of hospital and intensive care unit (ICU) stays are reduced, with a direct impact on costs and the quality of the health service.Objective
To compare the length of stay in the ICU, length of hospital stay, and post-operative mortality in ultra-fast-track extubated (uFTE) patients and those with conventional extubation (CE) after cardiac surgery.Methods
Longitudinal, analytical, retrospective study was conducted, with the period between the time of surgery and discharge being included as the study period.Results
A total of 396 patients older than 18 years who required cardiac surgery were included, of whom 207 patients had (uFTE) and 189 had CE. Although the groups were not comparable due to the statistical differences found, when performing the multivariate adjustment, uFTE maintained its statistical independence and was associated with lower cardiovascular morbidity, such as myocardial ischaemia (95% CI: 0.37-0.86; P = .01) and lower post-surgical vasopressor requirement (95% CI: 0.18-0.49; P < .01). No significant differences were found in the length of hospital stay, ICU stay, or post-operative mortality in the ICU.Conclusion
Implementing the uFTE strategy, decreases cardiovascular morbidity and vasopressor requirement. The change to uFTE should be accompanied by changes in models and practices in patient recovery to standardised protocols. This study shows that uFTE did not reduce the length of ICU stay, hospital stay, or mortality. 相似文献3.
《Anaesthesia and Intensive Care Medicine》2019,20(12):681-686
Tracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a common alternative. Prior to embarking upon intubation, a thorough patient history and examination must be undertaken by the laryngoscopist; equipment must be prepared and checked; a trained assistant present; and an experienced anaesthetist available in case assistance is required. Once the endotracheal tube has been placed, correct positioning must be confirmed via both clinical examination and monitoring, including capnography. Tracheal intubation is a procedure that should only be undertaken by trained operators and is not without risk. It is important to note that it is failure to oxygenate patients rather than failure to intubate that ultimately leads to serious morbidity and mortality. The Difficult Airway Society has produced guidelines on how to manage unanticipated difficulty in tracheal intubation; it is essential that every practitioner trained to intubate patients is familiar with these algorithms and the key principles of safe airway management. 相似文献
4.
Steven Elia Peter Liu Carol Chrusciel Alan Hilgenberg Charrisios Skourtis Demetrios Lappas 《Journal canadien d'anesthésie》1989,36(1):2-8
Global coronary blood flow and metabolism were measured in seven patients on the first postoperative day following coronary
revascularization to test the hypothesis that tracheal extubation produces adverse haemodynamic responses akin to those observed
during tracheal intubation. Regional coronary flow and metabolic measurements were made in five of the seven patients. Extubation
from a continuous positive airway pressure (CPAP) of 5 cm H2O was associated with a statistically significant rise in cardiac index from 3.44 ± 0.23 L · min-1 · m-2 to 3.73 ± 0.15L·min-1 ·m-2 related to an increase in stroke index, without significant changes in heart rate, mean arterial and pulmonary capillary
wedge pressure. Consequently the changes in myocardial oxygen consumption (8.52 ± 0.55 to 8.85 ± 0.93 ml · min-1) and coronary blood flow (172 ± 18 to 179 ± 17 ml·min-1) were less prominent than those reported during intubation, where substantial rises in myocardial oxygen consumption and
coronary flow occurred. Two patients experienced cardiac lactate production but there were no changes in systemic or coronary
haemodynamics, nor were there clinical or electrocardiographic signs of ischaemia. We conclude that extubation does not appear
to be associated with adverse systemic or coronary haemodynamic responses in patients following coronary bypass grafting.
However, the revascularized myocardium may remain vulnerable to anaerobic metabolism in the immediate postoperative period.
Pour savoir si comme ľintubation, ľextubation de la trachée provoque des perturbations hémodynamiques, on a mesuré le métabolisme
et la circulation coronarienne globale chez sept patients, au lendemain ďun pontage aorto-coronarien. On a aussi calculé les
valeurs régionales de ces mêmes variables pour cinq ďentre eux. Ľindex cardiaque de 3.44 ± 0.23 L · min-1 · m-2 sous pression positive en respiration spontanée (CPAP) de 5 cm. H2O s’est élevé à 3.73 ± 0.15 L · min-1 · m-2 post-extubation avec une augmentation significative du volume ďéjection. La fréquence cardiaque et les pressions artérielles
moyennes et capillaires pulmonaires n’ont pas changé. Ainsi ľaugmentation de la consommation ďoxygène du myocarde de 8.52
± 0.55 à 8.85 ± 0.93 ml · min-1 et celle du flot coronarien de 172 ± 18 à 179 ± 17 ml · min-1 ont été moindres que celles, importantes, déjà observées lors de ľintubation. On a noté chez deux patients une production
de lactate par le myocarde, sans changement de ľhémodynamic systémique et coronarienne non plus que de signe clinique ou électrocardiographique
ďischémie. Donc, après un pontage coronarien, ľextubation ne semble pas causer ďeffet néfaste sur les circulations systémique
et coronarienne, toutefois, le myocarde revascularisé peut demeurer sensible au métabolisme anaérobique. 相似文献
5.
Difficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling off the pilot balloon and valve assembly in order to deflate the cuff. 相似文献
6.
重症肌无力术后延长拔管时间的临床价值 总被引:6,自引:0,他引:6
目的 探讨重症肌无力 (MG)胸腺切除术后 ,延长气管拔管时间 ,减少气管切开的价值。方法 回顾分析 1978年至 2 0 0 2年 12月行MG胸腺切除 2 36例 ,按时间分A组 :1996年 12月以前手术者116例 ,对术后可能发生肌无力危象的高危因素病人施行预防性气管切开 ;B组 :1997年后手术 12 0例 ,对具发生危象高危因素者采用延长气管拔管时间 ,并对两组危象发生率及气管切开率进行比较。结果 全组发生危象 4 4例 (18 6 % ) ,气管切开 4 6例 (ARDS 1例除外 )占 19 5 %。其中A组发生危象 2 3例(19 8% ) ,气管切开 34例 (2 9 3% ) ;B组发生危象 2 1例 (17 5 % ) ,气管切开 12例 (10 % )。两组危象发生率无明显差异 ,但A组的气管切开率明显高于B组 (P <0 0 0 1)。结论 对MG胸腺切除术后具发生危象高危因素病人 ,采用延长气管插管时间及辅助通气 ,可显著减少气管切开率。 相似文献
7.
目的探讨可乐定对气管拔管应激反应的预防作用.方法22例气管插管全麻手术病人,随机分为对照组和可乐定组(每组11例).可乐定组病人于麻醉前 60 min 加服可乐定 5 μg*kg-1,其它麻醉前用药两组病人相同.分别在麻醉前、拔管前、拔管后1、2、5、10 min 采集动脉血标本,测定血浆儿茶酚胺、血管紧张素Ⅱ、皮质醇、血糖、血乳酸浓度,做血气分析,计录各时点的血流动力学参数.结果两组病人气管拔管期间血浆儿茶酚胺、皮质醇、血糖、血乳酸浓度均明显增高,可乐定组增高程度明显低于对照组.结论麻醉前服用可乐定能明显减轻气管拔管引起的应激反应. 相似文献
8.
黄烨平 《浙江中医药大学学报》2012,36(6):725-726
对2008年1月至2010年6月,在ICU发生意外拔管的16例气管插管病人的临床资料进行了总结分析。结果导致意外拔管的相关因素有:缺乏有效的固定、未使用镇静剂、未使用适当的肢体约束及护患沟通不良等。因此,对人工气道的患者应高度重视,重在预防,做到正确固定,充分沟通,适当镇静和肢体约束,是有效的护理措施。 相似文献
9.
《International Journal of Obstetric Anesthesia》2014,23(3):282-285
The difficult obstetric airway is a well-recognised anaesthetic challenge but little emphasis is placed on the difficulty of performing a safe tracheal extubation. We report the use of an airway exchange technique to extubate a difficult obstetric airway and discuss the role of these techniques in the obstetric population. 相似文献
10.
Julio E. González-Aguirre Claudia Paola Rivera-Uribe Erick Joel Rendón-Ramírez Rogelio Cañamar-Lomas Juan Antonio Serna-Rodríguez Roberto Mercado-Longoría 《Archivos de bronconeumologia》2019,55(4):195-200