Hernández-Sande C, Moret-Bonillo V, Alonso-Betanzos A
IEEE Trans Biomed Eng. 1989 May;36(5):559-64. doi: 10.1109/10.24259.
The withdrawal of mechanical ventilation generally presents no problems if carried out when the values of certain predictive physiological variables suggest that the patient will be able to breathe for him or herself. In certain cases, however, a more gradual weaning procedure is necessary, in which the amount of mechanical assistance provided is in some way reduced little by little. One of the usual means of achieving this gradual reduction is by intermittent mandatory ventilation (IMV), in which short bursts of mechanical ventilation are separated by progressively longer periods of "ventilator silence" which stimulate the patient's endogenous respiration. ESTER is an expert system in which the most widely accepted criteria are systematically called upon to supply advice to the clinician who has to prescribe a respiratory therapy regime suited to the needs of the patient. After effecting a preliminary prognosis of the patient's condition, ESTER asks for certain physiological parameters to be keyed in. Analysis of these parameters reveals the patient's condition and allows a recommended respiratory therapy to be designed.
如果在某些预测性生理变量的值表明患者能够自主呼吸时进行机械通气撤离，通常不会出现问题。然而，在某些情况下，需要更渐进的撤机程序，即逐步减少提供的机械辅助量。实现这种逐步减少的常用方法之一是间歇强制通气（IMV），其中短时间的机械通气间歇期会逐渐延长，形成“呼吸机沉默”期，以刺激患者的自主呼吸。ESTER是一个专家系统，它系统地调用最广泛接受的标准，为必须制定适合患者需求的呼吸治疗方案的临床医生提供建议。在对患者病情进行初步预后评估后，ESTER要求输入某些生理参数。对这些参数的分析揭示患者的病情，并允许设计推荐的呼吸治疗方案。
