deBoisblanc M W, Goldman R K, Mayberry J C, Brand D M, Pangburn P D, Soifer B E, Mullins R J
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
J Trauma. 2000 Aug;49(2):224-30; discussion 230-1. doi: 10.1097/00005373-200008000-00007.
Injured patients with pulmonary failure often require prolonged length of stay in an intensive care unit (ICU), which includes weaning from ventilatory support. In the last decade, noninvasive ventilation modes have been established as safe and effective. One method for accomplishing this mode of ventilation uses a simple bilevel ventilator. Because this ventilator has been successfully used in hospital wards, we postulated that bilevel ventilators could provide sufficient support during weaning from mechanical ventilation of injured patients in a non-ICU setting.
A retrospective review of trauma patients (August 1996-January 1999) undergoing bilevel positive pressure ventilation as the final phase of weaning was conducted. Before ward transfer with bilevel ventilation, conventionally ventilated ICU patients were changed to bilevel ventilation and were required to tolerate this mode for at least 24 hours. All patients had a tracheostomy as a secure airway. Outcomes analyzed included ICU length of stay, hospital length of stay, duration of mechanical ventilation, weaning success, complications, and survival.
Fifty-one patients (39 men, 12 women) with a mean age of 53 received more than 24 hours of bilevel positive pressure ventilation. Mean Injury Severity Score was 29, with blunt mechanisms of injury occurring in 90%. Chest or spinal cord injuries that affected pulmonary mechanics were present in 75% of patients. Ventilator-associated pneumonia was treated in 43% of patients. Mean ICU length of stay and hospital length of stay were 21 and 34 days, respectively. Weaning was successful in 89% of patients, whereas 11% were discharged to skilled nursing facilities still receiving bilevel positive pressure ventilation. Two patients died, neither from a pulmonary nor airway complication. Of the remaining 49 patients, 12 were weaned in the ICU and 37 were transferred to the ward with bilevel ventilatory support. The average length of ward ventilation was 6.5 +/- 5.4 days (n = 37).
Implementation of a program using bilevel ventilation to support the terminal phase of weaning seriously injured patients from mechanical ventilation was successful. After initiating this mode in the ICU, it was satisfactorily continued in standard surgical wards. Because this method enabled the withdrawal of ventilatory support in a non-ICU setting, its major advantage was reducing ICU length of stay.
患有肺功能衰竭的受伤患者通常需要在重症监护病房（ICU）长时间住院，这包括从机械通气支持中撤机。在过去十年中，无创通气模式已被确立为安全有效的方法。实现这种通气模式的一种方法是使用简单的双水平呼吸机。由于这种呼吸机已在医院病房成功使用，我们推测双水平呼吸机可以在非ICU环境中为受伤患者机械通气撤机期间提供足够的支持。
对1996年8月至1999年1月期间接受双水平正压通气作为撤机最后阶段的创伤患者进行回顾性研究。在使用双水平通气转至病房之前，常规通气的ICU患者改为双水平通气，并要求耐受这种模式至少24小时。所有患者均行气管切开术以确保气道安全。分析的结果包括ICU住院时间、住院时间、机械通气时间、撤机成功率、并发症和生存率。
51例患者（39例男性，12例女性），平均年龄53岁，接受双水平正压通气超过24小时。平均损伤严重度评分29分，90%为钝性损伤机制。75%的患者存在影响肺力学的胸部或脊髓损伤。43%的患者接受了呼吸机相关性肺炎的治疗。平均ICU住院时间和住院时间分别为21天和34天。89%的患者撤机成功，而11%出院至专业护理机构时仍接受双水平正压通气。2例患者死亡，均非死于肺部或气道并发症。其余49例患者中，12例在ICU撤机，37例在双水平通气支持下转至病房。平均病房通气时间为6.5±5.4天（n = 37）。
实施一项使用双水平通气支持严重受伤患者机械通气撤机最后阶段的方案是成功的。在ICU启动这种模式后，在标准外科病房中也能令人满意地继续使用。由于这种方法能够在非ICU环境中撤机，其主要优点是缩短了ICU住院时间。
