Division of Pulmonary & Critical Care, Department of Medicine, American University of Beirut, Beirut, Lebanon.
Curr Opin Anaesthesiol. 2012 Feb;25(1):42-7. doi: 10.1097/ACO.0b013e32834e6430.
Liberation from mechanical ventilation is a defining moment for intubated patients, and thus a critical clinical decision. Extubating the patient too early exposes the patient to extubation failure and reintubation. Waiting too long increases the complications of prolonged intubation. Tools to help the physician with this critical decision and to test readiness have been available for decades, and are continuously being improved. New methods to improve extubation outcomes are also being developed. This review covers the latest studies in order to help physicians take advantage of the latest developments in a rapidly evolving field.
This review highlights the recent advances in assessing and testing for readiness of weaning and liberation from mechanical ventilation, the cause of weaning failure, the value of weaning protocols, and the role of noninvasive positive pressure ventilation in liberating patients from invasive mechanical ventilation.
Recent findings are shedding more light on this topic, and transforming 'the artistic' aspect of weaning and liberation from mechanical ventilation into a more 'scientific' approach that will expedite liberation from mechanical ventilation yet without encountering high failure rates, and without exposing patients to unnecessary risks.
从机械通气中解脱出来是插管患者的一个决定性时刻，也是一个关键的临床决策。过早地将患者拔管会使患者面临拔管失败和重新插管的风险。等待时间过长会增加长时间插管的并发症。几十年来，一直有帮助医生做出这一关键决策和测试准备情况的工具，并且这些工具还在不断改进。新的方法也在不断开发以改善拔管结果。本文综述了最新的研究，以帮助医生利用这一快速发展领域的最新进展。
本文重点介绍了评估和测试脱机和机械通气准备情况的最新进展、脱机失败的原因、脱机方案的价值以及无创正压通气在将患者从有创机械通气中解放出来的作用。
最近的发现为这一主题提供了更多的线索，并将机械通气脱机的“艺术性”方面转变为更“科学”的方法，这将加快机械通气的解脱，但不会导致高失败率，也不会使患者面临不必要的风险。
