Pu Xue-Xue, Wang Jiong, Yan Xue-Bo, Jiang Xue-Qin
Department of Geriatric Pulmonary Diseases, Anhui Geriatric Institute, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
World J Emerg Med. 2015;6(3):196-200. doi: 10.5847/wjem.j.1920-8642.2015.03.006.
Because the continuity and integrity of the trachea are likely damaged to some extent after tracheostomy, the implementation of sequential ventilation has certain difficulties, and sequential invasive-noninvasive ventilation on patients after tracheostomy is less common in practice. The present study aimed to investigate the feasibility of invasive-noninvasive sequential weaning strategy in patients after tracheostomy.
Fifty patients including 24 patients with withdrawal of mechanical ventilation (conventional group) and 26 patients with sequential invasive-noninvasive weaning by directly plugging of tracheostomy (sequential group) were analyzed retrospectively after appearance of pulmonary infection control (PIC) window. The analysis of arterial blood gases, ventilator-associated pneumonia (VAP) incidence, the total duration of mechanical ventilation, the success rate of weaning and total cost of hospitalization were compared between the two groups.
Arterial blood gas analysis showed that the sequential weaning group was better than the conventional weaning group 1 and 24 hours after invasive ventilation. The VAP incidence was lowered, the duration of mechanical ventilation shortened, the success rate of weaning increased, and the total cost of hospitalization decreased.
Sequential invasive-noninvasive ventilator weaning is feasible in patients after tracheostomy.
由于气管切开术后气管的连续性和完整性可能会受到一定程度的破坏，实施序贯通气存在一定困难，气管切开术后患者的有创-无创序贯通气在实际应用中较少见。本研究旨在探讨气管切开术后患者有创-无创序贯撤机策略的可行性。
回顾性分析50例患者，其中包括24例撤机患者（常规组）和26例通过直接封堵气管切开处进行有创-无创序贯撤机的患者（序贯组），均在出现肺部感染控制（PIC）窗后进行分析。比较两组患者的动脉血气分析、呼吸机相关性肺炎（VAP）发生率、机械通气总时长、撤机成功率及住院总费用。
动脉血气分析显示，序贯撤机组在有创通气后1小时及24小时的情况均优于常规撤机组。VAP发生率降低，机械通气时长缩短，撤机成功率提高，住院总费用降低。
气管切开术后患者采用有创-无创序贯呼吸机撤机是可行的。
