A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients
A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients
复制标题
DOI：
10.1007/s001340101035
复制
发表时间：
2001-10-01
影响因子：
38.9
通讯作者：
Moreno, EG
中科院分区：
文献类型：
--
作者：
Farias, JA;Retta, A;Moreno, EG
目的：比较婴儿和儿童在使用压力支持或t片呼吸试验后成功拔管的百分比。设计：前瞻性随机研究。环境：三个内科-外科儿科重症监护病房（picu）。患者：257名连续接受机械通气至少48小时的婴儿和儿童，并被其主治医生认为准备接受呼吸试验。干预措施：患者被随机分配接受两种呼吸方式之一的试验：10cmh (2)O或T-piece压力支持。在停止机械通气前和通过t片呼吸的前5分钟内获得呼吸功能的床边测量。主治医生并不知道这些测量结果，在呼吸试验结束时是否给病人拔管的决定也是由他们做出的。测量结果及主要结果：压力支持组125例患者中，99例（79.2%）完成呼吸试验并拔管，但其中15例（15.1%）需要在48 h内重新插管。t片组132例患者中，102例（77.5%）完成呼吸试验并拔管。但其中13例（12.7%）需要在48小时内重新插管。呼吸试验后48小时仍拔管的患者百分比在压力支持组和t片组中没有差异（67.2%对67.4%,p = 0.97）。结论：在机械通气的婴儿和儿童中，采用10cmh (2)O压力支持或t片进行首次呼吸试验后，成功拔管的效果相同。
Objective: To compare the percentage of infants and children successfully extubated after a trial of breathing performed with either pressure support or T-piece.Design: Prospective and randomized study.Setting: Three medical-surgical pediatric intensive care units (PICUs).Patients: Two hundred fifty-seven consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a breathing trial by their primary physician.Interventions: Patients were randomly assigned to undergo a trial of breathing in one of two ways: pressure support of 10 cmH(2)O or T-piece. Bedside measurements of respiratory function were obtained immediately before discontinuation of mechanical ventilation and within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements, and the decision to extubate a patient at the end of the breathing trial was made by them.Measurements and main results: Of the 125 patients in the pressure support group, 99 (79.2 %) completed the breathing trial and were extubated, but 15 of them (15.1 %) required reintubation within 48 h. Of the 132 patients in the T-piece group, 102 (77.5 %) completed the breathing trial and were extubated, but 13 of them (12.7 %) required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after the breathing trial did not differ in the pressure support and T-piece groups (67.2 % versus 67.4 %, p = 0.97).Conclusions: In infants and children mechanically ventilated, successful extubation was achieved equally effectively after a first breathing trial performed with pressure support of 10 cmH(2)O or a T-piece.