Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia, Italy.
Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Montescano IRCCS, Italy.
Respir Care. 2019 Jan;64(1):17-25. doi: 10.4187/respcare.06280. Epub 2018 Sep 11.
Patients undergoing prolonged mechanical ventilation represent up to 15% of all patients requiring weaning from mechanical ventilation. Although recent guidelines have recommended including physiotherapy early during mechanical ventilation to speed the process of weaning, only indirect evidence supporting the use of physiotherapy is available for patients receiving prolonged mechanical ventilation. The aim of our study was to evaluate the effects of a physiotherapy program in subjects requiring prolonged mechanical ventilation and the correlates of successful weaning.
A retrospective analysis was performed on 1,313 consecutive patients admitted to a weaning unit over a 15-y period to be liberated from prolonged mechanical ventilation. Subjects underwent a program of intensive physiotherapy organized in 4 incremental steps (1-4) and were analyzed according to the steps achieved (> 2 steps or ≤ 2 steps). The rate of successful weaning was recorded, and possible predictors were considered. The 15-y period of observation was divided into 3 consecutive 5-y intervals.
Out of 560 subjects undergoing final analysis, 349 (62.3%) were successfully weaned. The weaning success rate was significantly greater in subjects attaining > 2 steps than in subjects who attained ≤ 2 steps (72.1% vs 55.9%, respectively, odds ratio = 2.04, 95% CI = 1.42-2.96, < .001). Stepwise logistic regression analysis showed that achievement of > 2 physiotherapy steps was the main predictor of successful weaning (odds ratio = 2.17, 95% CI = 1.48-3.23, < .001). Underlying disease was also a predictor of successful weaning. The overall rate of successful weaning decreased, and the median duration of weaning increased, during the period of observation.
Our data support the inclusion of physiotherapy in the management of patients requiring prolonged mechanical ventilation.
需要脱机的患者占所有需要脱机的机械通气患者的 15%。尽管最近的指南建议在机械通气期间早期开始物理治疗以加速脱机过程，但对于接受长时间机械通气的患者，仅提供了支持使用物理治疗的间接证据。我们的研究目的是评估物理治疗方案对需要长时间机械通气的患者的影响以及成功脱机的相关因素。
对 15 年内入住脱机病房以摆脱长时间机械通气的 1313 例连续患者进行回顾性分析。患者接受了一个强化物理治疗方案，该方案分为 4 个递增步骤（1-4），并根据所达到的步骤进行分析（> 2 步或≤ 2 步）。记录成功脱机的比例，并考虑可能的预测因素。观察期为 15 年，分为 3 个连续的 5 年间隔。
在 560 例最终分析的患者中，349 例（62.3%）成功脱机。达到> 2 步的患者脱机成功率明显高于达到≤ 2 步的患者（分别为 72.1%和 55.9%，优势比= 2.04，95%CI=1.42-2.96，<.001）。逐步逻辑回归分析显示，达到> 2 个物理治疗步骤是成功脱机的主要预测因素（优势比= 2.17，95%CI=1.48-3.23，<.001）。基础疾病也是成功脱机的预测因素。在观察期间，成功脱机的总体比例下降，脱机的中位时间延长。
我们的数据支持将物理治疗纳入需要长时间机械通气的患者的管理中。
