Kippnich Maximilian, Skazel Tobias, Klingshirn Hanna, Gerken Laura, Heuschmann Peter, Haas Kirsten, Schutzmeier Martha, Brandstetter Lilly, Weismann Dirk, Reuschenbach Bernd, Meybohm Patrick, Wurmb Thomas
Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Sektion Notfall- und Katastrophenmedizin, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
Katholische Stiftungshochschule München, München, Deutschland.
Med Klin Intensivmed Notfmed. 2023 May;118(4):269-276. doi: 10.1007/s00063-022-00941-5. Epub 2022 Jul 11.
Weaning from ventilators is not always finished in the primary intensive care unit (ICU) setting. Transfer to other treatment facilities is a sensitive stage in the treatment and rehabilitation of the weaning patient. The aim of the present study was to investigate transition management and interhospital transfer of weaning patients, with special emphasis on documentation quality.
A retrospective data analysis of one year (2018) in two ICUs of a university hospital was performed. All ventilated patients with the following tracer diagnoses were included: chronic obstructive pulmonary disease (COPD), asthma, patients with multiple injuries, pneumonia, sepsis, acute respiratory distress syndrome (ARDS), and cardiac arrest (ventilation > 24 h).
A total of 750 patients were included in the study (median age 64 [IQR 52.8-76]; 32% female). In all, 48 (6.4%) patients were not weaned at the time of transfer (especially sepsis and ARDS). Routine documentation was sufficient for the sections "spontaneous breathing trial", "assessment of readiness to wean" and "presumed weanability" to adequately assess the parameters of the German S2k guideline "prolonged weaning". Predominantly, these patients were transferred with tracheostoma (76%) to rehabilitation units (44%) by specialized physician-assisted patient transport ambulances (75%).
The transfer of ventilated patients after initial ICU stay is a relevant issue for interhospital transfer. Routine documentation of a structured weaning process is sufficient in core elements to describe the weaning process. This is of great importance for continuity in the further treatment of these patients.
在初级重症监护病房（ICU）环境中，撤机并非总能完成。转至其他治疗机构是撤机患者治疗与康复过程中的一个敏感阶段。本研究旨在调查撤机患者的过渡管理及医院间转运情况，特别强调文件记录质量。
对某大学医院两个ICU的一年（2018年）数据进行回顾性分析。纳入所有具有以下追踪诊断的机械通气患者：慢性阻塞性肺疾病（COPD）、哮喘、多发伤患者、肺炎、脓毒症、急性呼吸窘迫综合征（ARDS）以及心脏骤停（机械通气>24小时）。
本研究共纳入750例患者（中位年龄64岁[四分位间距52.8 - 76]；32%为女性）。总共有48例（6.4%）患者在转院时未成功撤机（尤其是脓毒症和ARDS患者）。常规记录对于“自主呼吸试验”“撤机准备评估”和“假定撤机可能性”等部分足以充分评估德国S2k指南“延长撤机”的参数。这些患者主要通过专科医生协助的患者转运救护车（75%）带着气管造口（76%）转至康复机构（44%）。
初次入住ICU后机械通气患者的转院是医院间转运的一个重要问题。结构化撤机过程的常规记录在核心要素方面足以描述撤机过程。这对于这些患者后续治疗的连续性非常重要。
