Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD.
Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD.
Crit Care Med. 2020 May;48(5):673-679. doi: 10.1097/CCM.0000000000004220.
Weaning protocols establish readiness-to-wean criteria to determine the opportune moment to conduct a spontaneous breathing trial. Weaning protocols have not been widely adopted or evaluated in ICUs in low- and middle-income countries. We sought to compare clinical outcomes between participants whose weaning trials were retrospectively determined to have been premature, opportune, or delayed based on when they met readiness-to-wean criteria.
Prospective, multicenter observational study.
Five medical ICUs in four public hospitals in Lima, Perú.
Adults with acute respiratory failure and at least 24 hours of invasive mechanical ventilation (n = 1,657).
None.
We established six readiness-to-wean criteria and retrospectively categorized our sample into three weaning groups: 1) premature: if the weaning trial took place before fulfilling all criteria, 2) opportune: if the weaning trial took place within 24 hours after fulfilling the criteria, and 3) delayed: if the weaning trial took place over 24 hours after fulfilling criteria. We compared 90-day mortality, ventilator-free days, ICU-free days, and hospital-free days between premature, opportune, and delayed weaning groups. In our sample, 761 participants (60.8%) were classified as having a premature weaning trial, 196 underwent opportune weaning (15.7%), and 295 experienced delayed weaning (23.6%). There was no significant difference in 90-day mortality between the groups. Both the premature and delayed weaning groups had poorer clinical outcomes with fewer ventilator-free days (-2.18, p = 0.008) and (-3.49, p < 0.001), ICU-free days (-2.25, p = 0.001) and (-3.72, p < 0.001), and hospital-free days (-2.76, p = 0.044) and (-4.53, p = 0.004), respectively, compared with the opportune weaning group.
Better clinical outcomes occur with opportune weaning compared with premature and delayed weaning. If readiness-to-wean criteria can be applied in resource-limited settings, it may improve ICU outcomes associated with opportune weaning.
撤机方案制定了撤机标准，以确定进行自主呼吸试验的适当时机。撤机方案在中低收入国家的 ICU 中并未得到广泛采用或评估。我们旨在比较根据达到撤机标准的时间，将撤机试验回顾性地确定为过早、适时或延迟的参与者的临床结局。
前瞻性、多中心观察性研究。
秘鲁利马的四家公立医院的五家医疗 ICU。
急性呼吸衰竭且接受至少 24 小时有创机械通气的成年人（n=1657）。
无。
我们确定了六项撤机标准，并将我们的样本回顾性地分为三组：1）过早：如果撤机试验在满足所有标准之前进行，2）适时：如果撤机试验在满足标准后 24 小时内进行，3）延迟：如果撤机试验在满足标准后超过 24 小时进行。我们比较了过早、适时和延迟撤机组之间的 90 天死亡率、无呼吸机天数、无 ICU 天数和无院天数。在我们的样本中，761 名参与者（60.8%）被归类为过早撤机，196 名接受适时撤机（15.7%），295 名经历延迟撤机（23.6%）。三组之间的 90 天死亡率无显著差异。过早和延迟撤机组的临床结局均较差，无呼吸机天数分别减少（-2.18，p=0.008）和（-3.49，p<0.001），无 ICU 天数分别减少（-2.25，p=0.001）和（-3.72，p<0.001），无院天数分别减少（-2.76，p=0.044）和（-4.53，p=0.004），与适时撤机组相比。
与过早和延迟撤机相比，适时撤机可带来更好的临床结局。如果在资源有限的情况下能够应用撤机标准，可能会改善与适时撤机相关的 ICU 结局。
