Weaning from Prolonged Mechanical Ventilation

描述（由申请人提供）：需要机械通气（MV）超过21天的患者占所有ICU费用的37%以上。因此，这些患者现在被转移到专门从事从MV中断奶的中心，即所谓的长期急性护理（LTAC）设施。尽管LTAC设施越来越多，但缺乏可靠地确定哪些患者可能断奶和加速断奶方法的测试研究。此外，很少或没有关于生存的决定因素，出院，和患者的生活质量（QOL）的感知在延长的过程中MV。因此，本提案的目的是确定需要长时间MV（定义为bbb21天）并已转移到LTAC设施的患者断奶的最有效方法，并确定哪些患者可能从MV中断奶。第二个目的是确定预测LTAC设施的生存和家庭出院的因素，以及长期MV对功能状态和生活质量的长期影响。为了实现这些目标，将对转入LTAC设施的患者进行一项前瞻性随机试验，以比较两种脱机技术的疗效：压力支持和自主呼吸试验。还将测量人口统计学、生理、心理和一般健康状况，以检验这些测量在预测断奶结果、生存和出院方面的准确性。出院后6个月和12个月在LTAC设施和患者居住地测量呼吸肌力量、握力及其与患者功能状态感知和生活质量的关系。本研究结果将为预测哪些患者可以断奶并存活回家、最有效的断奶方法以及延长MV对长期生活质量和功能状态的影响提供最可靠的方法。这些信息将首次为卫生保健提供者提供可靠的科学证据，并帮助他们为在LTAC设施断奶的患者制定客观的管理准则。

DESCRIPTION (provided by applicant): Patients requiring mechanical ventilation (MV) for more than 21 days account for more than 37% of all ICU costs. As such, these patients are now transferred to centers that specialize in weaning from MV, so called long-term acute care (LTAC) facilities. Despite the proliferation of LTAC facilities, research on tests that reliably identify which patients are likely to wean and methods for expediting weaning are lacking. In addition, little or no information is available regarding the determinants of survival, home discharge, and patient's perception of quality of life (QOL) after a prolonged course of MV. Thus, the aim of this proposal is to determine the most efficient way to wean patients who require prolonged MV (defined as >21 days) and have been transferred to an LTAC facility and to identify which patients are likely to wean from MV. The secondary aim is to determine the factors that predict survival and home discharge from a LTAC facility and the long-term impact of prolonged MV on functional status and QOL. To address these aims, a prospective, randomized trial in patients who are transferred to a LTAC facility will be done to compare the efficacy of two weaning techniques: pressure support and spontaneous breathing trials. Demographics, physiological, psychological, and general health status will also be measured to examine the accuracy of such measurements in predicting weaning outcome, survival, and home discharge. Respiratory muscles strength, handgrip strength, and their relationship to patient perception of functional status and QOL will be measured at the LTAC facility and the patient place of residence at 6 and 12 months after discharge. Findings from this proposal will provide novel insights into the most reliable means for predicting which patients can wean and survive to be discharged home, the most efficient method of weaning patients, and the impact of prolonged MV on long-term QOL and functional status. Such information will provide for the first time solid scientific evidence to health care providers, and help them formulate objective guidelines for the management of patients being weaned at a LTAC facility.