Frutos-Vivar Fernando, Esteban Andrés
Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain.
Cleve Clin J Med. 2003 May;70(5):389, 392-3, 397 passim. doi: 10.3949/ccjm.70.5.389.
It is often unclear when and how to wean patients from mechanical ventilation. We have devised an evidence-based protocol in which patients undergo a 30-minute trial of spontaneous breathing with a T tube or pressure support of 7 cm H2O. Those who can tolerate the trial are extubated, while those who cannot are reconnected to mechanical ventilation but undergo another trial every day until they can be extubated. More study is needed to improve the criteria to predict successful spontaneous breathing and extubation, and to clarify the role of non-invasive ventilation to avoid reintubation.
何时以及如何让患者脱离机械通气往往并不明确。我们制定了一项基于证据的方案，即让患者使用T形管或7厘米水柱的压力支持进行30分钟的自主呼吸试验。能够耐受该试验的患者进行拔管，而不能耐受的患者则重新连接机械通气，但每天进行另一次试验，直到能够拔管。需要更多的研究来改进预测自主呼吸和拔管成功的标准，并阐明无创通气在避免再次插管方面的作用。
