Tobin Martin J
Loyola University of Chicago Stritch School of Medicine, Edward Hines Jr. VA Hospital, Division of Pulmonary and Critical Care Medicine, 111N, 5th Avenue and Roosevelt Road, Hines, Illinois 601451, USA,
Intensive Care Med. 2006 Oct;32(10):1485-93. doi: 10.1007/s00134-006-0338-8. Epub 2006 Aug 8.
The approach to ventilator weaning has changed considerably over the past 30 years. Change has resulted from research in three areas: pathophysiology, weaning-predictor testing, and weaning techniques. Physiology research illuminated the mechanisms of weaning failure. It also uncovered markers of weaning success. Through more reliable prediction, patients whose weaning would have been tedious in the 1970s are now weaned more rapidly. The weaning story offers several lessons in metascience: importance of creativity, the asking of heretical questions, serendipity, mental-set psychology, cross-fertilization, and the hazards of precocity. Weaning research also illustrates how Kuhnian normal (me-too) science dominates any field. Making the next quantum leap in weaning will depend on spending less time on normal science and more on the raising (and testing) of maverick ideas.
在过去30年里，呼吸机撤机的方法发生了很大变化。这种变化源于三个领域的研究：病理生理学、撤机预测指标测试和撤机技术。生理学研究阐明了撤机失败的机制，还发现了撤机成功的标志。通过更可靠的预测，在20世纪70年代撤机过程会很漫长的患者，现在撤机速度更快了。撤机的故事在元科学方面提供了几个经验教训：创造力的重要性、提出异端问题、意外发现、思维定式心理学、交叉融合以及过早行动的风险。撤机研究还说明了库恩式常规（跟风）科学如何主导任何领域。要在撤机方面实现下一个重大飞跃，将取决于减少在常规科学上花费的时间，更多地关注提出（并检验）非传统的想法。
