Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Via Paradisa 2, Cisanello, Pisa, Italy.
Expert Rev Respir Med. 2010 Oct;4(5):685-92. doi: 10.1586/ers.10.58.
Up to 20% of patients requiring mechanical ventilation will suffer from difficult weaning (the need of more than 7 days of weaning after the first spontaneous breathing trial), which may depend on several reversible causes: respiratory and/or cardiac load, neuromuscular and neuropsychological factors, and metabolic and endocrine disorders. Clinical consequences (and/or often causes) of prolonged mechanical ventilation comprise features such as myopathy, neuropathy, and body composition alterations and depression, which increase the costs, morbidity and mortality of this. These difficult-to-wean patients may be managed in two type of units: respiratory intermediate-care units and specialized regional weaning centers. Two weaning protocols are normally used: progressive reduction of ventilator support (which we usually use), or progressively longer periods of spontaneous breathing trials. Physiotherapy is an important component of weaning protocols. Weaning success depends strongly on patients’ complexity and comorbidities, hospital organization and personnel expertise, availability of early physiotherapy, use of weaning protocols, patients’ autonomy and families’ preparation for home discharge with mechanical ventilation.
高达 20%需要机械通气的患者会出现撤机困难（第一次自主呼吸试验后需要超过 7 天的撤机），这可能取决于几个可逆转的原因：呼吸和/或心脏负荷、神经肌肉和神经心理因素以及代谢和内分泌紊乱。长时间机械通气的临床后果（和/或经常导致）包括肌病、神经病和身体成分改变以及抑郁等特征，这增加了这些患者的成本、发病率和死亡率。这些难以撤机的患者可以在两种类型的单位进行管理：呼吸中级护理病房和专门的区域撤机中心。通常使用两种撤机方案：呼吸机支持的逐步降低（我们通常使用），或自主呼吸试验的时间逐渐延长。物理治疗是撤机方案的重要组成部分。撤机的成功强烈取决于患者的复杂性和合并症、医院组织和人员专业知识、早期物理治疗的可用性、撤机方案的使用、患者的自主性以及家庭为带机出院做好准备。
