协议指导与医生指导的无创通气撤机：对慢性阻塞性肺疾病患者的影响。
Protocol-directed versus physician-directed weaning from noninvasive ventilation: the impact in chronic obstructive pulmonary disease patients.
机构信息
Department of Respiratory Medicine, First Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China.
出版信息
J Trauma Acute Care Surg. 2012 May;72(5):1271-5. doi: 10.1097/TA.0b013e318249a0d5.
BACKGROUND
Noninvasive ventilation (NIV), a technique widely used in intensive care units (ICUs), eliminates the need for many patients in respiratory failure to undergo intubation. However, few articles have described how to wean patients from NIV. Herein, we put forward a protocol to be performed by respiratory therapists to wean patients from NIV.
METHODS
A prospective, randomized, controlled trial was performed in a respiratory ICU of a teaching hospital. Respiratory therapists screened patients daily. In the protocol-directed weaning group, the weaning attempt was initiated according to the protocol. In the physician-directed weaning group, the weaning attempt was initiated according to physicians' orders.
RESULTS
At randomization, patients in the two groups had similar clinical characteristics. A total of 73 patients were successfully weaned from NIV (37 in the protocol-directed group and 36 in the physician-directed group). The preponderance of them (64%) was chronic obstructive pulmonary disease patients. Compared with physician-directed weaning, protocol-directed weaning reduced the duration of NIV (4.4 ± 2.5 days vs. 2.6 ± 1.5 days, respectively, p < 0.001) and the duration of the ICU stay (8.1 ± 5.5 days vs. 5.8 ± 2.7 days, respectively, p = 0.02). In the protocol-directed group, the successful weaning rate was 57%, 27%, 13%, 0%, and 3% on the 1st, 2nd, 3rd, 4th, and 5th days after randomization, respectively.
CONCLUSIONS
Protocol-directed weaning reduces the duration of NIV and the duration of the ICU stay.
LEVEL OF EVIDENCE
II.
背景
无创通气（NIV）是一种在重症监护病房（ICU）广泛应用的技术，它使许多呼吸衰竭患者无需进行气管插管。然而，很少有文章描述如何对接受 NIV 的患者进行撤机。在此，我们提出了一个由呼吸治疗师执行的方案，以帮助患者从 NIV 撤机。
方法
在一家教学医院的呼吸 ICU 中进行了一项前瞻性、随机、对照试验。呼吸治疗师每天对患者进行筛查。在方案指导的撤机组中，根据方案开始撤机尝试。在医生指导的撤机组中，根据医生的医嘱开始撤机尝试。
结果
在随机分组时，两组患者的临床特征相似。共有 73 例患者成功从 NIV 撤机（方案指导组 37 例，医生指导组 36 例）。其中大多数（64%）为慢性阻塞性肺疾病患者。与医生指导的撤机相比，方案指导的撤机减少了 NIV 的使用时间（分别为 4.4±2.5 天和 2.6±1.5 天，p<0.001）和 ICU 住院时间（分别为 8.1±5.5 天和 5.8±2.7 天，p=0.02）。在方案指导组中，分别在随机分组后第 1、2、3、4 和 5 天，撤机成功的比例为 57%、27%、13%、0%和 3%。
结论
方案指导的撤机可减少 NIV 的使用时间和 ICU 住院时间。
证据等级
II。
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