Matić Ivo, Majerić-Kogler Visnja
Department of Anesthesiology and Intensive Care, Dr Josip Bencevic General Hospital, Slavonski Brod, Croatia.
Croat Med J. 2004 Apr;45(2):162-6.
To compare T-tube and pressure support ventilation (PSV) as two methods of weaning patients from mechanical ventilation.
A randomized prospective study included 260 patients who received mechanical ventilation for more than 48 h, and who were admitted to the intensive care unit (ICU) at Dr. Josip Bencevic General Hospital in Slavonski Brod, between August 1999 and October 2000. After fulfilling the clinical criteria for weaning, the patients were randomly assigned to a 2-h trial of spontaneous breathing either with a T-tube system (n=110) or PSV of 8 cm H2O (n=150). The patients who fulfilled weaning criteria at the end of the 2-h trial were extubated. If any signs of poor procedure tolerance were observed during the 2-h trial, the mechanical ventilation was reinstituted. In such patients, the same weaning procedure was repeated after 24 h, or when the patient's clinical condition permitted. Two methods of weaning were compared according to the patient's clinical characteristics, objective parameters, and procedure outcome.
Eighty (73%) patients in the T-tube group and 120 (80%) patients in PSV group successfully completed the 2-h trial and were extubated. Thirty patients in the T-tube group and 30 in the PSV group had weaning difficulties. Total length of additional mechanical ventilation and total length of stay at ICU were significantly shorter in patients undergoing PSV weaning (p<0.001 for all, Man-Whitney test). For the patients with weaning difficulties and Acute Physiology and Chronic Health Evaluation (APACHE) II score >20 on admission, PSV was the superior method of weaning according to rate of successful extubation, time of weaning from mechanical ventilation, total time of mechanical ventilation, and length of ICU stay (p<0.001 for all, Man-Whitney test).
In patients with weaning difficulties, PSV with 8 cm H(2)O was more successful weaning method than T-tube.
比较T管和压力支持通气（PSV）作为两种使患者脱离机械通气的方法。
一项随机前瞻性研究纳入了260例接受机械通气超过48小时的患者，这些患者于1999年8月至2000年10月间入住斯拉沃尼亚布罗德的约西普·本采维奇综合医院重症监护病房（ICU）。在满足撤机的临床标准后，患者被随机分配到使用T管系统进行2小时自主呼吸试验组（n = 110）或8 cm H₂O压力支持通气组（n = 150）。在2小时试验结束时符合撤机标准的患者予以拔管。如果在2小时试验期间观察到任何操作耐受性差的迹象，则重新进行机械通气。对于这类患者，在24小时后或患者临床状况允许时重复相同的撤机程序。根据患者的临床特征、客观参数和操作结果对两种撤机方法进行比较。
T管组80例（73%）患者和PSV组120例（80%）患者成功完成2小时试验并拔管。T管组和PSV组各有30例患者撤机困难。接受PSV撤机的患者额外机械通气的总时长和在ICU的总住院时长显著更短（所有p<0.001，曼-惠特尼检验）。对于撤机困难且入院时急性生理与慢性健康状况评估（APACHE）II评分>20的患者，根据成功拔管率、脱离机械通气时间、机械通气总时长和ICU住院时长，PSV是更优的撤机方法（所有p<0.001，曼-惠特尼检验）。
对于撤机困难的患者，8 cm H₂O的PSV是比T管更成功的撤机方法。
