Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Indiana University School of Medicine and Riley Children Hospital at Indiana University Health, Indianapolis, IN.
Pediatr Crit Care Med. 2022 Dec 1;23(12):999-1008. doi: 10.1097/PCC.0000000000003025. Epub 2022 Jul 14.
To map the evidence for ventilation liberation practices in pediatric respiratory failure using the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards.
CINAHL, MEDLINE, COCHRANE, and EMBASE. Trial registers included the following: ClinicalTrials.gov, European Union clinical trials register, International Standardized Randomized Controlled Trial Number register.
Abstracts were screened followed by review of full text. Articles published in English language incorporating a heterogeneous population of both infants and older children were assessed.
None.
Weaning can be considered as the process by which positive pressure is decreased and the patient becomes increasingly responsible for generating the energy necessary for effective gas exchange. With the growing use of noninvasive respiratory support, extubation can lie in the middle of the weaning process if some additional positive pressure is used after extubation, while for some extubation may constitute the end of weaning. Testing for extubation readiness is a key component of the weaning process as it allows the critical care practitioner to assess the capability and endurance of the patient's respiratory system to resume unassisted ventilation. Spontaneous breathing trials (SBTs) are often seen as extubation readiness testing (ERT), but the SBT is used to determine if the patient can maintain adequate spontaneous ventilation with minimal ventilatory support, whereas ERT implies the patient is ready for extubation.
Current literature suggests using a structured approach that includes a daily assessment of patient's readiness to extubate may reduce total ventilation time. Increasing evidence indicates that such daily assessments needs to include SBTs without added pressure support. Measures of elevated load as well as measures of impaired respiratory muscle capacity are independently associated with extubation failure in children, indicating that these should also be assessed as part of ERT.
使用真实主义和元叙事证据综合：不断发展的标准出版标准，绘制小儿呼吸衰竭通气解放实践的证据图。
CINAHL、MEDLINE、COCHRANE 和 EMBASE。试验登记处包括以下内容：ClinicalTrials.gov、欧盟临床试验登记处、国际标准化随机对照试验编号登记处。
筛选摘要，然后审查全文。评估了发表的纳入婴儿和年龄较大儿童异质人群的英文文章。
无。
我们可以将撤机视为降低正压并使患者越来越能够产生有效气体交换所需能量的过程。随着无创呼吸支持的广泛应用，如果在拔管后使用一些额外的正压，拔管可能处于撤机过程的中间，而对于某些患者，拔管可能构成撤机的结束。进行拔管准备测试是撤机过程的关键组成部分，因为它使重症监护医生能够评估患者呼吸系统恢复自主通气的能力和耐力。自主呼吸试验（SBT）通常被视为拔管准备测试（ERT），但 SBT 用于确定患者是否可以在最小通气支持下维持足够的自主通气，而 ERT 则意味着患者已准备好拔管。
目前的文献表明，使用包括每日评估患者拔管准备情况的结构化方法可能会减少总通气时间。越来越多的证据表明，这种每日评估需要包括没有额外压力支持的 SBT。负荷增加的测量值以及呼吸肌容量受损的测量值与儿童拔管失败独立相关，这表明这些也应作为 ERT 的一部分进行评估。
