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脱离MV的中心，即所谓的长期急性护理（LTAC）设施。尽管LTAC设施激增，但缺乏可靠识别哪些患者可能断奶的测试和加速断奶的方法的研究。此外，很少或没有关于生存的决定因素，家庭出院，和患者的生活质量（QOL）的看法后，一个长期的MV的信息。因此，本提案的目的是确定需要延长MV（定义为>21天）并已转移至LTAC机构的患者的最有效断奶方式，并确定哪些患者可能从MV中断奶。第二个目的是确定预测生存率和从LTAC设施出院的因素，以及长期MV对功能状态和QOL的长期影响。为了实现这些目标，将在转移到LTAC设施的患者中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，以检查这些测量在预测断奶结局、存活率和出院时的准确性。出院后6个月和12个月，将在LTAC机构和患者居住地测量呼吸肌力量、握力及其与患者对功能状态和QOL的感知的关系。这项提案的结果将为预测哪些患者可以脱机并存活出院回家提供最可靠的方法，脱机患者的最有效方法以及延长MV对长期QOL和功能状态的影响提供新的见解。这些信息将首次为医疗保健提供者提供可靠的科学证据，并帮助他们制定在LTAC设施中断奶的患者管理的客观指南。

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.