Westhoff M, Geiseler J, Schönhofer B, Pfeifer M, Dellweg D, Bachmann M, Randerath W
Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer.
Universität Witten-Herdecke, Witten.
Pneumologie. 2021 Feb;75(2):113-121. doi: 10.1055/a-1337-9848. Epub 2020 Dec 22.
The logistical and infectious peculiarities and requirements challenge the intensive care treatment teams aiming at a successful liberation of patients from long-term mechanical ventilation. Especially in the pandemic, it is therefore important to use all potentials for weaning and decannulation, respectively, in patients with prolonged weaning.Weaning centers represent units of intensive medical care with a particular specialization in prolonged weaning. They are an integral part of a continuous care concept for these patients. A systematic weaning concept in the pandemic includes structural, personnel, equipment, infectiological and hygienic issues. In addition to the S2k guideline "Prolonged weaning" this position paper hightlights a new classification in prolonged weaning and organizational structures required in the future for the challenging pandemic situation. Category A patients with high weaning potential require a structured respiratory weaning in specialized weaning units, so as to get the greatest possible chance to realize successful weaning. Patients in category B with low or currently nonexistent weaning potential should receive a weaning attempt after an intermediate phase of further stabilization in an out-of-hospital ventilator unit. Category C patients with no weaning potential require a permanent out-of-hospital care, alternatively finishing mechanical ventilation with palliative support.Finally, under perspective in the position paper the following conceivable networks and registers in the future are presented: 1. locally organized regional networks of certified weaning centers, 2. a central, nationwide register of weaning capacities accordingly the already existing DIVI register and 3. registration of patients in difficult or prolonged weaning.
后勤保障、感染特性及要求给重症监护治疗团队带来了挑战，这些团队旨在成功帮助患者摆脱长期机械通气。因此，尤其在疫情期间，充分利用各种潜力分别对撤机困难和拔管困难的患者进行撤机和拔管十分重要。撤机中心是重症医疗护理单元，专门处理撤机困难问题。它们是这类患者持续护理理念的一个组成部分。疫情期间的系统性撤机理念涵盖结构、人员、设备、感染学及卫生等问题。除了S2k指南“撤机困难”外，本立场文件还强调了撤机困难的新分类以及未来应对具有挑战性的疫情形势所需的组织结构。撤机潜力高的A类患者需要在专门的撤机单元进行结构化的呼吸撤机，以便获得最大的成功撤机机会。撤机潜力低或目前没有撤机潜力的B类患者应在院外呼吸机单元经过进一步稳定的中间阶段后尝试撤机。无撤机潜力的C类患者需要长期的院外护理，或者在姑息支持下结束机械通气。最后，本立场文件展望了未来可能出现的以下网络和登记系统：1. 本地组织的经认证撤机中心区域网络；2. 仿照现有DIVI登记系统建立的全国性撤机能力中央登记系统；3. 对撤机困难或撤机时间延长的患者进行登记。
