Role of sleep on respiratory failure after extubation in the ICU

Annals of Intensive Care

René Robert¹  Damien Marie¹  Rémi Coudroy¹  Stephanie Barrau¹  Jean-Pierre Frat¹  Christophe Rault¹  Arnaud W. Thille¹  Adrien Pépin-Lehalleur¹  Faustine Reynaud¹  Xavier Drouot¹  Justine Bardin¹  Clément Beuvon¹  Vanessa Bironneau¹  Jean-Claude Meurice¹ 

[1] INSERM CIC 1402, ALIVE Research Group, University of Poitiers;

关键词: Airway extubation;    Ventilator weaning;    Intensive care unit;    Sleep;    Mechanical ventilation;   

DOI  :  10.1186/s13613-021-00863-z

来源: DOAJ

【 摘 要 】

Abstract Background Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others. Results Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23). Conclusions Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation.

【 授权许可】

Unknown