Vitacca M, Vianello A, Colombo D, Clini E, Porta R, Bianchi L, Arcaro G, Vitale G, Guffanti E, Lo Coco A, Ambrosino N
Salvatore Maugeri Foundation, IRCCS, Lung Function Unit, Scientific Institute of Gussago, Via Pinidolo 23, 25064 Gussago, Italy.
Am J Respir Crit Care Med. 2001 Jul 15;164(2):225-30. doi: 10.1164/ajrccm.164.2.2008160.
We designed a prospective multicenter randomized controlled study in three long-term weaning units (LWU) to evaluate which protocol, inspiratory pressure support ventilation (PSV) or spontaneous breathing trials (SB), is more effective in weaning patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation for more than 15 d. Fifty-two of 75 patients, failing an initial T-piece trial at admission, were randomly assigned to PSV or SB (26 in both groups). No significant difference was found in weaning success rate (73% versus 77% in the PSV and SB group, respectively), mortality rate (11.5% versus 7.6%), duration of ventilatory assistance (181 +/- 161 versus 130 +/- 106 h), LWU (33 +/- 12 versus 35 +/- 19 d), or total hospital stay. The results of these defined protocols were retrospectively compared with an "uncontrolled clinical practice" in weaning historical control patients. The overall 30-d weaning success rate was significantly greater (87% versus 70%) and the time spent under mechanical ventilation by survived and weaned patients was shorter in the patients in the study than in historical control patients (103 +/- 144 versus 170 +/- 127 h). The LWU and hospital stays were also significantly shorter (27 +/- 12 versus 38 +/- 18 and 38 +/- 17 versus 47 +/- 18 d). Spontaneous breathing trials and decreasing levels of PSV are equally effective in difficult-to-wean patients with COPD. The application of a well-defined protocol, independent of the mode used, may result in better outcomes than uncontrolled clinical practice.
我们在三个长期撤机单元（LWU）设计了一项前瞻性多中心随机对照研究，以评估哪种方案，即吸气压力支持通气（PSV）或自主呼吸试验（SB），在撤机慢性阻塞性肺疾病（COPD）且需要机械通气超过15天的患者中更有效。75例患者中有52例在入院时首次T形管试验失败，被随机分配到PSV或SB组（每组26例）。在撤机成功率（PSV组和SB组分别为73%对77%）、死亡率（11.5%对7.6%）、通气辅助时间（181±161对130±106小时）、LWU住院时间（33±12对35±19天）或总住院时间方面未发现显著差异。将这些明确方案的结果与撤机历史对照患者的“非对照临床实践”进行回顾性比较。研究组患者的总体30天撤机成功率显著更高（87%对70%），存活且撤机患者的机械通气时间比历史对照患者短（103±144对170±127小时）。LWU住院时间和住院总时间也显著更短（27±12对38±18天和38±17对47±18天）。自主呼吸试验和降低PSV水平在难以撤机的COPD患者中同样有效。应用明确的方案，无论使用何种模式，可能比非对照临床实践产生更好的结果。
