A COMPARISON OF 4 METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION
A COMPARISON OF 4 METHODS OF WEANING PATIENTS FROM MECHANICAL VENTILATION
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DOI：
10.1056/nejm199502093320601
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发表时间：
1995-02-09
影响因子：
158.5
通讯作者：
BLANCO, J
中科院分区：
文献类型：
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作者：
ESTEBAN, A;FRUTOS, F;BLANCO, J
背景在重症监护病房中，患者脱离机械通气是一个重要的问题。断奶通常是以经验的方式进行，并没有一个标准化的方法。我们进行了一项前瞻性、随机、多中心研究，涉及546例接受机械通气平均（+/-SD）7.5+/-6.1天且医生认为已准备好脱机的患者。130名患者在两小时的自主呼吸试验中出现呼吸窘迫。这些患者被随机分配接受四种脱机技术之一：间歇性指令通气，其中呼吸机频率最初设定为平均（+/-SD）10.0+/-2.2次呼吸/分钟，然后如果可能，每天至少降低两次，通常为2 - 4次呼吸/分钟（29例患者）;压力支持通气，其中压力支持最初设置为18.0+/-6.1 cm水柱，然后可能减少2 - 4 cm水柱，每天至少两次（37例患者）;间歇性自主呼吸试验，如果可能，每天进行两次或更多次（33例患者）;或每天一次自主呼吸试验（31例患者）。每项技术均遵循标准化方案。间断指令通气的中位脱机时间为5天（第一个四分位数，3天;第三四分位数，11天），压力支持通气4天（分别为2天和12天），间歇性3天（多次）自主呼吸试验（分别为2天和6天），每日一次自主呼吸试验为3天（分别为1天和6天）。调整其他协变量后，每日一次自主呼吸试验的成功脱机率高于间歇性指令通气（率比，2.83; 95%置信区间，1.36至5.89; P
Background. Weaning patients from mechanical ventilation is an important problem in intensive care units. Weaning is usually conducted in an empirical manner, and a standardized approach has not been developed.Methods. We carried out a prospective, randomized, multicenter study involving 546 patients who had received mechanical ventilation for a mean (+/-SD) of 7.5+/-6.1 days and who were considered by their physicians to be ready for weaning. One hundred thirty patients had respiratory distress during a two-hour trial of spontaneous breathing. These patients were randomly assigned to undergo one of four weaning techniques: intermittent mandatory ventilation, in which the ventilator rate was initially set at a mean (+/-SD) of 10.0+/-2.2 breaths per minute and then decreased, if possible, at least twice a day, usually by 2 to 4 breaths per minute (29 patients); pressure-support ventilation, in which pressure support was initially set at 18.0+/-6.1 cm of water and then reduced, it possible, by 2 to 4 cm of water at least twice a day (37 patients); intermittent trials of spontaneous breathing, conducted two or more times a day if possible (33 patients); or a once-daily trial of spontaneous breathing (31 patients). Standardized protocols were followed for each technique.Results. The median duration of weaning was 5 days for intermittent mandatory ventilation (first quartile, 3 days; third quartile, 11 days), 4 days for pressure-support ventilation (2 and 12 days, respectively), 3 days for intermittent (multiple) trials of spontaneous breathing (2 and 6 days, respectively), and 3 days for a once-daily trial of spontaneous breathing (1 and 6 days, respectively). After adjustment for other covariates, the rate of successful weaning was higher with a once-daily trial of spontaneous breathing than with intermittent mandatory ventilation (rate ratio, 2.83; 95 percent confidence interval, 1.36 to 5.89; P