Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
Department of Pneumology and Intensive Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany.
Respiration. 2022;101(10):959-969. doi: 10.1159/000525604. Epub 2022 Aug 17.
Prolonged mechanical ventilation (PMV) and weaning failure are factors associated with prolonged hospital length of stay and increased morbidity and mortality. In addition to the burden these places on patients and their families, it also imposes high costs on the public health system. The aim of this systematic review was to identify risk factors for PMV and weaning failure.
The study was conducted according to PRISMA guidelines. After a comprehensive search of the COCHRANE Library, CINHAL, Web of Science, MEDLINE, and the LILACS Database a PubMed request was made on June 8, 2020. Studies that examined risk factors for PMV, defined as mechanical ventilation ≥96 h, weaning failure, and prolonged weaning in German and English were considered eligible; reviews, meta-analyses, and studies in very specific patient populations whose results are not necessarily applicable to the majority of ICU patients as well as pediatric studies were excluded from the analysis. This systematic review was registered in the PROSPERO register under the number CRD42021271038.
Of 532 articles identified, 23 studies with a total of 23,418 patients met the inclusion criteria. Fourteen studies investigated risk factors of PMV including prolonged weaning, 9 studies analyzed risk factors of weaning failure. The concrete definitions of these outcomes varied considerably between studies. For PMV, a variety of risk factors were identified, including comorbidities, site of intubation, various laboratory or blood gas parameters, ventilator settings, functional parameters, and critical care scoring systems. The risk of weaning failure was mainly related to age, previous home mechanical ventilation (HMV), cause of ventilation, and preexisting underlying diseases. Elevated PaCO2 values during spontaneous breathing trials were indicative of prolonged weaning and weaning failure.
A direct comparison of risk factors was not possible because of the heterogeneity of the studies. The large number of different definitions and relevant parameters reflects the heterogeneity of patients undergoing PMV and those discharged to HMV after unsuccessful weaning. Multidimensional scores are more likely to reflect the full spectrum of patients ventilated in different ICUs than single risk factors.
长时间机械通气（PMV）和脱机失败是与住院时间延长、发病率和死亡率增加相关的因素。除了这些因素给患者及其家庭带来的负担外，它们还给公共卫生系统带来了高昂的成本。本系统评价的目的是确定 PMV 和脱机失败的危险因素。
该研究按照 PRISMA 指南进行。在对 COCHRANE 图书馆、CINHAL、Web of Science、MEDLINE 和 LILACS 数据库进行全面检索后，于 2020 年 6 月 8 日在 PubMed 上提出了请求。研究对象为德国和英语文献中检查 PMV（定义为机械通气≥96 小时）、脱机失败和延长脱机风险因素的研究；排除了综述、荟萃分析以及结果不一定适用于大多数 ICU 患者的非常特定患者人群的研究以及儿科研究。本系统评价已在 PROSPERO 登记处注册，注册号为 CRD42021271038。
在 532 篇文章中，有 23 项研究（共 23418 名患者）符合纳入标准。14 项研究调查了 PMV 的危险因素，包括延长脱机，9 项研究分析了脱机失败的危险因素。这些结果的具体定义在研究之间差异很大。对于 PMV，确定了多种危险因素，包括合并症、插管部位、各种实验室或血气参数、呼吸机设置、功能参数和重症监护评分系统。脱机失败的风险主要与年龄、既往家庭机械通气（HMV）、通气原因和预先存在的基础疾病有关。自主呼吸试验期间升高的 PaCO2 值提示延长脱机和脱机失败。
由于研究的异质性，不可能直接比较危险因素。大量不同的定义和相关参数反映了接受 PMV 治疗和不成功脱机后转至 HMV 治疗的患者的异质性。多维评分比单个危险因素更能反映不同 ICU 中通气患者的全貌。
