Department of Anesthesiology & Critical Care Medicine, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Intensive Care Med. 2022 Nov;37(11):1417-1425. doi: 10.1177/08850666221095436. Epub 2022 Jul 11.
Since the inception of critical care medicine and artificial ventilation, literature and research on weaning has transformed daily patient care in intensive care units (ICU). As our knowledge of mechanical ventilation (MV) improved, so did the need to study patient-ventilator interactions and weaning predictors. Randomized trials have evaluated the use of protocol-based weaning (vs. usual care) to study the duration of MV in ICUs, different techniques to conduct spontaneous breathing trials (SBT), and strategies to eventually extubate a patient whose initial SBT failed. Despite considerable milestones in the management of multiple diseases contributing to reversible respiratory failure, in the application of early rehabilitative interventions to preserve muscle integrity, and in ventilator technology that mitigates against ventilator injury and dyssynchrony, major barriers to successful liberation from MV persist. This review provides a broad encompassing view of weaning classification, causes of weaning failure, and evidence behind weaning predictors and weaning modes.
自重症医学和人工通气问世以来，有关撤机的文献和研究改变了重症监护病房（ICU）的日常患者护理。随着我们对机械通气（MV）的了解不断加深，研究患者-呼吸机交互作用和撤机预测指标的需求也有所增加。随机试验评估了基于方案的撤机（与常规护理相比）在 ICU 中 MV 持续时间、进行自主呼吸试验（SBT）的不同技术以及最终为初始 SBT 失败的患者拔管的策略。尽管在导致可逆性呼吸衰竭的多种疾病的管理、早期康复干预以保持肌肉完整性的应用以及减轻呼吸机损伤和失同步的呼吸机技术方面取得了相当大的里程碑式进展，但仍存在从 MV 成功撤离的主要障碍。本综述提供了对撤机分类、撤机失败的原因以及撤机预测指标和撤机模式背后证据的广泛全面的看法。
