Epstein Carol Diane, El-Mokadem Naglaa, Peerless Joel R
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
Am J Crit Care. 2002 Jul;11(4):369-77.
As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.
To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.
After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.
The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower
Further study of weaning in older adults is warranted.
由于重症监护病房中的老年人越来越需要长期机械通气，因此需要准确的指标来表明何时准备好撤机，以避免过早拔管。
描述接受长期机械通气的老年人肺部和全身变量的时间变化。
在撤机尝试3天未成功后，对10名60岁以上的创伤和外科手术患者进行每日监测。测量先前报道的机械通气持续时间和撤机结果的预测指标，包括血流动力学和气体交换变量、呼吸氧耗以及伯恩斯撤机评估计划的评分。
6名能够撤机的患者（中位年龄71.5岁）比4名不能撤机的患者（中位年龄80岁）年轻。能够撤机的患者在重症监护病房住院第11天时已准备好撤机，还需要5.5天的机械通气；不能撤机的患者直到第17天才准备好撤机。所有患者在撤机初期氧耗均增加；成功撤机的患者在拔管前氧耗下降。能够撤机的患者呼吸频率、最大吸气压力、动脉血氧分压与吸入氧分数之比以及平均动脉压较高，呼吸氧耗和中心静脉压较低。
有必要对老年人撤机进行进一步研究。
