Vaz Inês Machado, Maia Maeco, Castro E Melo Ana M, Rocha Afonso
Serviço de Medicina Física e de Reabilitação, Hospital S. João, Porto, Portugal.
Acta Med Port. 2011 Mar-Apr;24(2):299-308. Epub 2011 May 20.
Mechanical ventilation is probably the medical intervention which resulted in more lifes saved in the history of Medicine. However, it is associated with several potential deleterious consequences, especially when it's maintained for unnecessarily long periods or, on the other hand, when suspended before full recovery is attained. Shortening the duration of mechanical ventilation and of the weaning process should be a clinical priority, outweighing the risks of extubation failure. Definite criteria and optimal timing for weaning initiation are still controversial, with several proposed clinical intervention protocols usually consisting of daily screening for weaning potential (daily weaning screening). Nowadays, most hospitals in developed countries have placed rehabilitation as an essential therapeutic intervention in critically ill patients. Nonetheless, its precise role varies from unit to unit, taking into account the country, local traditions, experience and technical quality of the professionals The authors present an overview of different respiratory and neuromuscular rehabilitation strategies currently available through the clinical course of invasively ventilated patients and throughout the weaning process.
机械通气可能是医学史上挽救生命最多的医疗干预措施。然而，它也会带来一些潜在的有害后果，特别是在机械通气时间过长或在患者完全康复之前就停止通气的情况下。缩短机械通气时间和撤机过程应成为临床首要任务，其重要性超过了拔管失败的风险。撤机开始的确切标准和最佳时机仍存在争议，目前有几种临床干预方案，通常包括每日筛查撤机可能性（每日撤机筛查）。如今，发达国家的大多数医院已将康复作为重症患者的一项基本治疗干预措施。尽管如此，考虑到国家、当地传统、专业人员的经验和技术水平，其确切作用在不同科室之间存在差异。作者概述了目前在有创通气患者的临床过程及整个撤机过程中可用的不同呼吸和神经肌肉康复策略。
