Clinical Relevance of Classification According to Weaning Difficulty
Clinical Relevance of Classification According to Weaning Difficulty
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DOI：
10.4187/respcare.00842
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发表时间：
2011-05-01
期刊：
影响因子：
2.5
通讯作者：
L'Her, Erwan
中科院分区：
文献类型：
--
作者：
Tonnelier, Alexandre;Tonnelier, Jean-Marie;L'Her, Erwan
目的：评价2005年国际共识会议提出的机械通气撤机分类系统在机械通气48 h以上患者中的临床意义，并评价其与预后的相关性。方法：我们在一家教学医院的12床重症监护室（ICU）进行了一项回顾性队列研究。我们纳入了需要> 48小时机械通气和通过自主呼吸试验（SBT）的患者。根据标准化方案指导程序监测撤机和镇静。我们从病历数据库中收集了生理特征、机械通气持续时间、ICU和住院时间以及死亡率的数据。我们采用前瞻性标准化方法评估了一年死亡率。采用多因素logistic回归分析评估撤机类别与结局之间的相关性。结果：我们纳入了329例通气事件，其中115例患者通过了至少一次SBT。34例患者（30%）成功完成第一次SBT（简单脱机组），47例患者（40%）成功完成第二次或第三次SBT或脱机时间少于7天（困难脱机组），34例患者（30%）需要超过3次SBT或脱机时间超过7天（延长脱机组）。简单脱机组、困难脱机组和延长脱机组的ICU和住院死亡率有显著差异。脱机时间延长是ICU住院时间延长（比值比15.11，95%CI 1.61-141.91，P = 0.01）和住院死亡率（比值比3.66，95%CI 0.99-13.51）的独立危险因素。然而，断奶过程不影响1年死亡率（比值比2.61，95% CI 0.82-8.35）。结论：新的脱机分类系统与临床相关，与ICU和住院死亡率相关，但与1年死亡率无关。
OBJECTIVE: To evaluate the clinical relevance of the weaning from mechanical ventilation classification system derived from the 2005 international consensus conference, in patients who receive mechanical ventilation for more than 48 hours, and evaluate its correlation with prognosis. METHODS: We conducted a retrospective cohort study in a 12-bed intensive care unit (ICU) in a teaching hospital. We included patients who required > 48 hours of mechanical ventilation and who passed a spontaneous breathing trial (SBT). Weaning and sedation were monitored according to standardized protocol-directed procedures. We collected data on physiological characteristics, mechanical ventilation duration, ICU and hospital stay, and mortality from the medical records database. We assessed one-year mortality with a prospective, standardized method. Multivariate logistic regression was performed to evaluate the association between weaning categories and outcome. RESULTS: We included 329 ventilation episodes, in which 115 patients passed at least one SBT. Thirty-four patients (30%) succeeded in their first SBT (simple weaning group), 47 patients (40%) succeeded in their 2nd or 3rd SBT or in less than 7 days of weaning (the difficult weaning group), and 34 patients (30%) required more than 3 SBTs or more than 7 days of weaning (the prolonged weaning group). There were significant differences in ICU and hospital mortality between the simple, difficult, and prolonged-weaning groups. Prolonged weaning was an independent risk factor for longer ICU stay (odds ratio 15.11, 95% CI 1.61-141.91, P = .01) and hospital mortality (odds ratio 3.66, 95% CI 0.99-13.51). However, the weaning process did not impact one-year mortality (odds ratio 2.61, 95% CI 0.82-8.35). CONCLUSIONS: The new weaning classification system is clinically relevant and correlates to ICU and hospital mortality, but not to one-year mortality.