Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, 75005 Paris, France; Service de médecine intensive - réanimation, département R3S, site Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France.
Inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, 75005 Paris, France; Service de médecine intensive - réanimation, département R3S, site Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France.
Rev Neurol (Paris). 2022 Jan-Feb;178(1-2):111-120. doi: 10.1016/j.neurol.2021.08.005. Epub 2021 Oct 18.
In the intensive care unit (ICU), weaning from mechanical ventilation follows a step-by-step process that has been well established in the general ICU population. However, little data is available in brain injury patients, who are often intubated to protect airways and prevent central hypoventilation. In this narrative review, we describe the general principles of weaning and how these principles can be adapted to brain injury patients. We focus on three major issues regarding weaning from mechanic ventilation in brain injury patients: (1) sedation protocol, (2) weaning and extubation protocol and criteria, (3) criteria, timing and technique for tracheostomy.
在重症监护病房（ICU）中，机械通气的脱机过程遵循着已经在普通 ICU 人群中确立的逐步进行的原则。然而，在经常需要插管以保护气道和预防中枢性低通气的脑损伤患者中，可用的数据很少。在这篇叙述性综述中，我们描述了脱机的一般原则，以及如何将这些原则应用于脑损伤患者。我们重点介绍了脑损伤患者机械通气脱机的三个主要问题：（1）镇静方案，（2）脱机和拔管方案和标准，（3）气管切开术的标准、时机和技术。
