Bruells C S, Bickenbach J, Marx G
Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
Med Klin Intensivmed Notfmed. 2018 Mar;113(2):94-100. doi: 10.1007/s00063-016-0192-6. Epub 2016 Jul 13.
Weaning from mechanical ventilation is generally not the most urgent topic on many ICUs, because acutely endangered patients are usually the staff's main focus. Nevertheless, even these patients whose underlying problem has been mostly solved-whether it was neurologic, internal or surgical-are in need of a structured weaning strategy. The aim of this weaning "road map" is ventilator independence, decannulation and regaining of muscular strength. Achieving of these aims needs a well-educated team of physicians, nurses, respiratory/physical therapists, logopedists and pychologists. Assessment of patient health status, including respiratory muscle function must be part of the overtaking procedure to be able to focus on the main problem that may be causative for the inability to wean so far. Every weaning unit must be able to organize the future treatment of patients (different ward inside the hospital, rehabilitation) or the transfer into a (ventilated) home care situation.
在许多重症监护病房，脱离机械通气通常并非最紧迫的议题，因为急危重症患者通常是医护人员的主要关注对象。然而，即使是那些潜在问题大多已解决的患者——无论病因是神经方面、内科还是外科——也需要一套结构化的撤机策略。这个撤机“路线图”的目标是实现自主通气、拔除气管插管并恢复肌肉力量。要实现这些目标，需要一支由医生、护士、呼吸/物理治疗师、语言治疗师和心理学家组成的专业团队。对患者健康状况进行评估，包括呼吸肌功能评估，必须成为交接过程的一部分，以便能够聚焦于可能是迄今为止导致无法撤机的主要问题。每个撤机单元都必须能够规划患者未来的治疗（医院内不同病房、康复治疗），或将患者转至（带通气设备的）家庭护理环境。
