Tobin M J, Yang K
Division of Pulmonary and Critical Care Medicine, Edward Hines Jr Veterans Administration Hospital, Loyola University of Chicago Stritch School of Medicine, Illinois.
Crit Care Clin. 1990 Jul;6(3):725-47.
Although the majority of patients can be easily weaned from mechanical ventilation, a substantial minority pose considerable difficulty. These patients account for a disproportionate amount of health care costs, and they pose enormous clinical, economic, and ethical problems. The major determinants of weaning outcome include the adequacy of pulmonary gas exchange, respiratory muscle pump function, and psychological problems. Many of the physiologic indices that have been used to predict weaning outcome are frequently inaccurate. Several techniques of weaning can be used, and there are no data to suggest the superiority of one technique over another. Management of the problem patient should be directed at the underlying cause of ventilator dependency, and an organized plan should be followed.
尽管大多数患者能够轻松地撤掉机械通气，但仍有相当一部分患者存在很大困难。这些患者产生的医疗费用占比过高，并且带来了巨大的临床、经济和伦理问题。撤机结果的主要决定因素包括肺气体交换的充分性、呼吸肌泵功能以及心理问题。许多曾用于预测撤机结果的生理指标常常不准确。可以采用多种撤机技术，而且没有数据表明一种技术优于另一种技术。对这类问题患者的管理应针对呼吸机依赖的根本原因，并应遵循一个有条理的计划。
