Villalba Darío, Plotnikow Gustavo, Feld Viviana, Rivero Vairo Noelia, Scapellato José, Díaz Nielsen Ernesto
Clínica Basilea, Buenos Aires, Argentina. E-mail:
Medicina (B Aires). 2015;75(1):11-7.
The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.
本研究的目的是描述入住撤机中心（WC）接受有创机械通气（MV）的人群，分析其病情演变并确定撤机失败的预测因素。回顾了2005年5月至2012年1月期间入住呼吸护理服务部门的763例患者的病历；在415例接受气管切开和机械通气的患者中，选取了372例进行分析。对不同变量作为撤机失败预测因素进行了分析。入住患者的平均年龄为69岁（标准差14.7），57%为男性。在重症监护病房（ICU）的中位住院时间为33天（四分位间距IQR 26 - 46）。86%的病例入住ICU是由于医疗原因。在WC住院期间，186例（50%）患者在中位时间13天（四分位间距 - IQR 5 - 38）成功撤机。年龄是撤机失败的一个预测因素。当我们研究机械通气部分脱机的亚组人群时，发现慢性阻塞性肺疾病（COPD）病史和年龄是预测因素。尽管25%的患者在住院2周前死亡或需要转诊至更复杂的中心，但超过一半的患者能够永久脱离有创机械通气（MV），这可以支持阿根廷MV和康复中心对慢性危重症患者的护理，因为这些中心的患者尽管发生并发症的可能性很高，但仍有撤机的机会。
