Ezingeard Eric, Diconne Eric, Guyomarc'h Stéphane, Venet Christophe, Page Dominique, Gery Pierre, Vermesch Régine, Bertrand Monique, Pingat Juliette, Tardy Bernard, Bertrand Jean-Claude, Zeni Fabrice
Intensive Care Unit, University Hospital Bellevue, 42055, St Etienne cedex 2, France.
Intensive Care Med. 2006 Jan;32(1):165-9. doi: 10.1007/s00134-005-2852-5. Epub 2005 Nov 10.
Evidence that PS may facilitate weaning from mechanical ventilation (MV), although not confirmed by randomized trials, prompted us to investigate whether patients could be weaned with PS after failing a T-tube trial.
This was a prospective, non-randomized study in two French intensive care units.
One hundred eighteen patients were enrolled and underwent a T-tube trial, after which 87 were extubated. Thirty-one underwent a further trial with PS, after which 21 were extubated.
All patients under MV >24 h meeting the criteria for a weaning test underwent a 30-min T-tube trial. If this was successful, they were immediately extubated. Otherwise, a 30-min trial with +7 cm H2O PS was initiated with an individualized pressurization slope and trigger adjustment. If all weaning criteria were met, the patients were extubated; otherwise, MV was reinstated.
The extubation failure rate at 48 h did not differ significantly between the groups: 11/87 (13%) versus 4/21 (19%), P=0.39. The groups were comparable with regard to endotracheal tube diameter, MV duration, the use of non-invasive ventilation (NIV) after extubation, initial severity score, age and underlying pathology, except for COPD. A significantly higher percentage of patients with COPD was extubated after the trial with PS (8/21-38%) than after a single T-tube trial (11/87-13%) (P=0.003).
Of the patients, 21/118 (18%) could be extubated after a trial with PS, despite having failed a T-tube trial. The reintubation rate was not increased. This protocol may particularly benefit patients who are most difficult to wean, notably those with COPD.
尽管随机试验尚未证实，但有证据表明压力支持（PS）可能有助于机械通气（MV）撤机，这促使我们研究在T管试验失败后患者是否能用PS撤机。
这是一项在法国两个重症监护病房进行的前瞻性、非随机研究。
118例患者入组并接受T管试验，其中87例拔管。31例患者进一步接受PS试验，之后21例拔管。
所有接受MV超过24小时且符合撤机测试标准的患者均接受30分钟的T管试验。如果试验成功，立即拔管。否则，以个体化的加压斜率和触发调节启动30分钟的+7 cm H₂O PS试验。如果满足所有撤机标准，则为患者拔管；否则，恢复机械通气。
两组在48小时时的拔管失败率无显著差异：11/87（13%）对4/21（19%），P = 0.39。除慢性阻塞性肺疾病（COPD）外，两组在气管插管直径、机械通气持续时间、拔管后无创通气（NIV）的使用、初始严重程度评分、年龄和基础病理方面具有可比性。与单次T管试验后（11/87 - 13%）相比，COPD患者在PS试验后拔管的比例显著更高（8/21 - 38%）（P = 0.003）。
在118例患者中，21例（18%）尽管T管试验失败，但在PS试验后仍可拔管。再插管率未增加。该方案可能对最难撤机的患者特别有益，尤其是COPD患者。
