Institute of Pneumology, University Witten/Herdecke, Clinic for Pneumology and Allergology, Centre for Sleep and Ventilation Medicine, Bethanien Hospital, Solingen 42699, Germany.
Chron Respir Dis. 2013 Aug;10(3):135-40. doi: 10.1177/1479972313493099.
There has been a rise in the number of patients requiring long-term ventilation, both in the in-hospital and the out-of-hospital setting. Despite this, little is known about the subsequent clinical course of these patients following hospital discharge. The purpose of this study was to determine the frequency and management of respiratory incidents in patients with invasive out-of-hospital ventilation living in a nursing home allied to a weaning centre. We evaluated retrospectively the protocols that are used to monitor the patients over a period of 2 months. The average time from hospital discharge was 386 ± 330 days. Of the total 17 patients, 9 (53%) patients remained free from any respiratory incidents, while the remaining 8 (47%) patients were responsible for a total of 95 respiratory incidents. Patients that suffered respiratory incidents had been ventilated at home for an average of 194 days, while the others were receiving out-of-hospital ventilation for an average of 557 days. Desaturation (17), dyspnoea (17) and reduced general condition (10) were the most common respiratory incidents. Also, the use of an Ambu bag (bag valve mask; 17), request for a pneumologist review (12) and replacement of the tracheal cannula (7) were the most common interventions. Respiratory incidents are common in invasive home mechanical ventilation, and so home mechanical ventilation needed to be organized safely. Being allied to a weaning centre helps to organize invasive home mechanical ventilation in a safe manner over the long-term ventilation.
需要长期通气的患者数量在住院和院外环境中都有所增加。尽管如此，对于这些患者出院后的后续临床过程知之甚少。本研究的目的是确定在与脱机中心相关联的疗养院中接受院外有创通气的患者发生呼吸事件的频率和管理方法。我们回顾性评估了在 2 个月期间监测患者的方案。从出院到平均时间为 386±330 天。在总共 17 名患者中，9 名（53%）患者没有发生任何呼吸事件，而其余 8 名（47%）患者共发生 95 次呼吸事件。发生呼吸事件的患者在家中通气的平均时间为 194 天，而其他人在院外通气的平均时间为 557 天。呼吸事件中最常见的是低氧血症（17 例）、呼吸困难（17 例）和一般情况恶化（10 例）。此外，最常见的干预措施包括使用复苏囊（球囊面罩；17 例）、请求肺病专家复查（12 例）和更换气管插管（7 例）。侵入性家庭机械通气中呼吸事件很常见，因此需要安全地组织家庭机械通气。与脱机中心相关联有助于长期通气期间安全地组织侵入性家庭机械通气。
