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Use of a train-of-four ratio of 0.95 versus 0.9 for tracheal extubation: an exploratory analysis of POPULAR data.

使用 0.95 与 0.9 的四列比用于气管拔管: 流行数据的探索性分析。

  • 影响因子:2.83
  • DOI:10.1016/j.bja.2019.08.023
  • 作者列表:"Blobner M","Hunter JM","Meistelman C","Hoeft A","Hollmann MW","Kirmeier E","Lewald H","Ulm K
  • 发表时间:2020-01-01
Abstract

BACKGROUND:The prospective observational European multicentre cohort study (POPULAR) of postoperative pulmonary complications (NCT01865513) did not demonstrate that adherence to the recommended train-of-four ratio (TOFR) of 0.9 before extubation was associated with better pulmonary outcomes from the first postoperative day up to hospital discharge. We re-analysed the POPULAR data as to whether there existed a better threshold for TOFR recovery before extubation to reduce postoperative pulmonary complications in patients who had quantitative neuromuscular monitoring (87% acceleromyography). METHODS:To identify the optimal TOFR, the complete case cohort of patients with quantitative neuromuscular monitoring (n=3150) was split into several pairs of sub-cohorts related to TOFR values from 0.86 to 0.96; values of 0.97 and higher could not be used as the sub-cohorts were too small. The optimal TOFR was considered to have the lowest P-value from multivariate logistic regression calculated for each of the TOFR values. Data are presented as adjusted absolute risk reduction or median difference with 95% confidence interval. RESULTS:Extubating patients with TOFR >0.95 rather than >0.9 reduced the adjusted risk of postoperative pulmonary complications by 3.5% (0.7-6.0%) from that reported in POPULAR (11.3%). Increasing the recommended TOFR from 0.9 to 0.95 reduced the adjusted risk by 4.9% (1.2-8.5%). Sub-cohorts resulting from 1:1 propensity score matching revealed that sugammadex had been given in higher doses by 0.30 (0.13-0.48) mg kg-1 in the sub-cohort with TOFR > 0.95. CONCLUSIONS:A post hoc analysis of patients receiving quantitative monitoring of neuromuscular function suggests that postoperative pulmonary complications are reduced for TOFR > 0.95 before tracheal extubation compared with TOFR > 0.9. TRIAL REGISTRATION NUMBER:NCT01865513.

摘要

背景: 术后肺部并发症的前瞻性观察性欧洲多中心队列研究 (POPULAR) (NCT01865513) 并没有证明遵守推荐的四联比 (TOFR) 拔管前的 0.9 与术后第一天至出院时更好的肺部结局相关。我们重新分析了接受定量神经肌肉监测 (87% 加速肌动造影) 的患者拔管前 TOFR 恢复是否存在更好的阈值以减少术后肺部并发症的流行数据。 方法: 确定最佳 TOFR,定量神经肌肉监测患者的完整病例队列 (n = 3150) 分成几对与 TOFR 值相关的子队列,从 0.86 到 0.96; 0.97 及更高的值不能使用,因为子队列太小。从多变量 logistic 回归中计算每个 TOFR 值的最佳 TOFR 被认为具有最低的 P 值。数据显示为调整后的绝对风险降低或 95% 置信区间的中值差异。 结果: TOFR> 0.95 而不是> 0.9 的拔管患者术后肺部并发症的调整后风险比流行报道 (3.5%) 降低了 0.7 (6.0%-11.3%)。将推荐的 TOFR 从 0.9 提高到 0.95,调整后的风险降低了 4.9% (1.2-8.5%)。1:1 倾向评分匹配得出的子队列显示,在 TOFR> 0.30 的子队列中,sugammadex 以较高剂量给予 0.13 (0.48-0.95) mg · kg-1。 结论: 对接受神经肌肉功能定量监测的患者进行事后分析表明,与 TOFR> 0.95 相比,气管拔管前 TOFR> 0.9 的患者术后肺部并发症减少。 试用注册号: nct01865513。

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影响因子:3.94
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作者列表:["Bernstein DM","Toth B","Rogers RA","Kling DE","Kunzendorf P","Phillips JI","Ernst H"]

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DOI:10.1042/BST20191010
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