Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Spain.
Minerva Anestesiol. 2012 Sep;78(9):1046-53. Epub 2012 Jun 28.
Although weaning predictors have been extensively explored in weaning research, their use is currently under debate. From all the stages of mechanical ventilation, the measurements of weaning predictors have been considered by some authors as imperative in order to progress weaning and initiate a weaning trial. However, this practice is rejected by other authors who considered that these tests are not necessary to perform a weaning trial, based in a meta-analysis study from the American College of Chest Physicians. Among all the weaning predictors, the frequency-to-tidal volume ratio (f/VT) remains the most important predictor of weaning. Other predictors have been defined, but their narrow predictive capacity or the requirement of specific technology, have limited their use. The variability of the results obtained by the efficacy of f/VT is probably explained because in most cases weaning is initiated late, when pre-test probability of weaning success is high. In order to reduce weaning duration, weaning strategies must be performed earlier, when a failed weaning trial probably is poor tolerated and the use of f/VT could have a role. New applications of weaning predictors must be clarified in future research, in order to progress in weaning in the context of new studies. Weaning is still a challenging period during mechanical ventilation.
虽然在撤机研究中已经广泛探索了撤机预测指标，但目前对其应用仍存在争议。在机械通气的所有阶段中，一些作者认为，为了推进撤机并开始撤机试验，撤机预测指标的测量是必不可少的。然而，另一些作者则反对这种做法，他们认为，根据美国胸科医师学会的一项荟萃分析研究，这些测试对于进行撤机试验并不是必需的。在所有的撤机预测指标中，频率与潮气量之比（f/VT）仍然是撤机的最重要预测指标。已经定义了其他预测指标，但由于其预测能力有限或需要特定技术，因此限制了它们的使用。f/VT 疗效获得的结果的可变性可能是由于在大多数情况下，撤机启动较晚，此时撤机成功的预测试概率较高。为了缩短撤机时间，必须更早地实施撤机策略，因为那时失败的撤机试验可能很难耐受，而 f/VT 的使用可能会发挥作用。未来的研究必须阐明撤机预测指标的新应用，以便在新的研究背景下推进撤机。在机械通气期间，撤机仍然是一个具有挑战性的时期。
