Sancho Jesus, Servera Emilio, Jara-Palomares Luis, Barrot Emilia, Sanchez-Oro-Gómez Raquel, Gómez de Terreros F Javier, Martín-Vicente M Jesús, Utrabo Isabel, Núñez M Belen, Binimelis Alicia, Sala Ernest, Zamora Enrique, Segrelles Gonzalo, Ortega-Gonzalez Angel, Masa Fernando
Respiratory Care Unit, Respiratory Medicine Dept, Hospital Clínico Universitario, Valencia, Spain; INCLIVA Institute of Health Research, Valencia, Spain.
Respiratory Care Unit, Respiratory Medicine Dept, Hospital Clínico Universitario, Valencia, Spain; INCLIVA Institute of Health Research, Valencia, Spain; Dept of Physical Therapy, Universitat de Valencia, Valencia, Spain.
ERJ Open Res. 2016 Oct 28;2(4). doi: 10.1183/23120541.00061-2016. eCollection 2016 Oct.
Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01-1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97). NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.
长期危重症患者常需接受长时间机械通气。在这些患者撤机过程中，无创通气（NIV）的作用仍不明确。本研究旨在确定NIV的价值，以及是否有一个参数可以预测长期危重症患者在撤机过程中对NIV的需求。我们进行了一项前瞻性研究，纳入了入住西班牙呼吸护理病房的长期危重症患者。所采用的撤机方法包括逐步进行自主呼吸试验。当自主呼吸试验的持续时间无法延长至超过18小时时，患者转至NIV。本研究共纳入231例长期危重症患者。198例（85.71%）患者撤机成功（平均撤机时间25.45±16.71天），其中40例（21.4%）在撤机过程中需要NIV。预测NIV需求的变量是入住呼吸护理病房时的动脉血二氧化碳分压（比值比1.08（95%可信区间1.01 - 1.15），p = 0.013），截断点为45.5 mmHg（敏感性0.76，特异性0.67，阳性预测值0.76，阴性预测值0.97）。NIV是长期危重症患者撤机过程中的一种有用工具。入住呼吸护理病房时尽管进行机械通气仍存在高碳酸血症是撤机过程中对NIV需求的主要预测因素。
