Shi Zhong-Hua, Jonkman Annemijn H, Tuinman Pieter Roel, Chen Guang-Qiang, Xu Ming, Yang Yan-Lin, Heunks Leo M A, Zhou Jian-Xin
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Intensive Care, Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands.
Ann Transl Med. 2021 Apr;9(7):548. doi: 10.21037/atm-20-6407.
Spontaneous breathing trials (SBTs) have been shown to improve outcomes in critically ill patients. However, in patients with brain injury, indications for intubation and mechanical ventilation are different from those of non-neurological patients, and the role of an SBT in patients with brain injury is less established. The aim of the present study was to compare key respiratory variables acquired during a successful SBT between patients with successful ventilator liberation versus failed ventilator liberation.
In this prospective study, patients with brain injury (≥18 years of age), who completed a 30-min SBT, were enrolled. Airway pressure, flow, esophageal pressure, and diaphragm electrical activity (ΔEAdi) were recorded before (baseline) and during the SBT. Respiratory rate (RR), tidal volume, inspiratory muscle pressure (ΔPmus), ΔEAdi, and neuromechanical efficiency (ΔPmus/ΔEAdi) of the diaphragm were calculated breath by breath and compared between the liberation success and failure groups. Failed liberation was defined as the need for invasive ventilator assistance within 48 h after the SBT.
In total, 46 patients (51.9±13.2 years, 67.4% male) completed the SBT. Seventeen (37%) patients failed ventilator liberation within 48 h. Another 11 patients required invasive ventilation within 7 days after completing the SBT. There were no differences in baseline characteristics between the success and failed groups. In-depth analysis showed similar changes in patterns and values of respiratory physiological parameters between the groups.
In patients with brain injury, ventilator liberation failure was common after successful SBT. In-depth physiological analysis during the SBT did not provide data to predict successful liberation in these patients.
The trial was registered at ClinicalTrials.gov (No. NCT02863237).
自主呼吸试验（SBTs）已被证明可改善重症患者的预后。然而，在脑损伤患者中，插管和机械通气的指征与非神经系统疾病患者不同，SBT在脑损伤患者中的作用尚不明确。本研究的目的是比较成功脱机患者与脱机失败患者在成功的SBT期间获得的关键呼吸变量。
在这项前瞻性研究中，纳入了完成30分钟SBT的脑损伤（≥18岁）患者。在SBT前（基线）和期间记录气道压力、流量、食管压力和膈肌电活动（ΔEAdi）。逐次计算膈肌的呼吸频率（RR）、潮气量、吸气肌压力（ΔPmus）、ΔEAdi和神经机械效率（ΔPmus/ΔEAdi），并在脱机成功组和失败组之间进行比较。脱机失败定义为SBT后48小时内需要有创通气支持。
共有46例患者（51.9±13.2岁，67.4%为男性）完成了SBT。17例（37%）患者在48小时内脱机失败。另外11例患者在完成SBT后7天内需要有创通气。成功组和失败组的基线特征无差异。深入分析显示，两组之间呼吸生理参数的模式和值变化相似。
在脑损伤患者中，成功的SBT后脱机失败很常见。SBT期间的深入生理分析未提供预测这些患者成功脱机的数据。
该试验已在ClinicalTrials.gov注册（编号：NCT02863237）。
