Réanimation Médicale, Pôle Urgences-Anesthésie- Réanimation, Centre Hospitalier Universitaire Brest, Brest, France.
Respir Care. 2011 May;56(5):583-90. doi: 10.4187/respcare.00842. Epub 2011 Jan 27.
To evaluate the clinical relevance of the weaning from mechanical ventilation classification system derived from the 2005 international consensus conference, in patients who receive mechanical ventilation for more than 48 hours, and evaluate its correlation with prognosis.
We conducted a retrospective cohort study in a 12-bed intensive care unit (ICU) in a teaching hospital. We included patients who required > 48 hours of mechanical ventilation and who passed a spontaneous breathing trial (SBT). Weaning and sedation were monitored according to standardized protocol-directed procedures. We collected data on physiological characteristics, mechanical ventilation duration, ICU and hospital stay, and mortality from the medical records database. We assessed one-year mortality with a prospective, standardized method. Multivariate logistic regression was performed to evaluate the association between weaning categories and outcome.
We included 329 ventilation episodes, in which 115 patients passed at least one SBT. Thirty-four patients (30%) succeeded in their first SBT (simple weaning group), 47 patients (40%) succeeded in their 2nd or 3rd SBT or in less than 7 days of weaning (the difficult weaning group), and 34 patients (30%) required more than 3 SBTs or more than 7 days of weaning (the prolonged weaning group). There were significant differences in ICU and hospital mortality between the simple, difficult, and prolonged-weaning groups. Prolonged weaning was an independent risk factor for longer ICU stay (odds ratio 15.11, 95% CI 1.61-141.91, P = .01) and hospital mortality (odds ratio 3.66, 95% CI 0.99-13.51). However, the weaning process did not impact one-year mortality (odds ratio 2.61, 95% CI 0.82-8.35).
The new weaning classification system is clinically relevant and correlates to ICU and hospital mortality, but not to one-year mortality.
评估源于 2005 年国际共识会议的机械通气撤机分类系统在接受机械通气超过 48 小时的患者中的临床相关性，并评估其与预后的相关性。
我们在一家教学医院的 12 床重症监护病房（ICU）进行了一项回顾性队列研究。我们纳入了需要机械通气超过 48 小时且通过自主呼吸试验（SBT）的患者。撤机和镇静通过标准化的基于方案的程序进行监测。我们从病历数据库中收集生理特征、机械通气时间、ICU 和住院时间以及死亡率的数据。我们使用前瞻性、标准化方法评估了一年死亡率。使用多变量逻辑回归评估了撤机类别与结局之间的关系。
我们纳入了 329 个通气周期，其中 115 名患者至少通过了一次 SBT。34 名患者（30%）在第一次 SBT 中成功（简单撤机组），47 名患者（40%）在第二次或第三次 SBT 中成功或在少于 7 天的撤机时间内成功（困难撤机组），34 名患者（30%）需要超过 3 次 SBT 或超过 7 天的撤机时间（延长撤机组）。在简单、困难和延长撤机组之间，ICU 和医院死亡率存在显著差异。延长撤机是 ICU 住院时间延长（优势比 15.11，95%CI 1.61-141.91，P =.01）和医院死亡率（优势比 3.66，95%CI 0.99-13.51）的独立危险因素。然而，撤机过程对一年死亡率没有影响（优势比 2.61，95%CI 0.82-8.35）。
新的撤机分类系统具有临床相关性，与 ICU 和医院死亡率相关，但与一年死亡率无关。
