Sunrise Hospital and Medical Center, Las Vegas, NV, USA.
Sunrise Hospital and Medical Center, Las Vegas, NV, USA.
Am J Infect Control. 2023 Dec;51(12):1321-1323. doi: 10.1016/j.ajic.2023.06.013. Epub 2023 Jun 22.
Acute respiratory distress syndrome (ARDS) is a severe and life-threatening condition that can occur in critically ill patients. Mechanical ventilation is a commonly used intervention with ARDS patients, but weaning patients off the ventilator can be challenging. An ARDSnet-like ventilator weaning protocol was implemented with the goal of reducing triggers for ventilator-associated events (VAEs).
The implementation of the new protocol was used to complete a retrospective investigation of patient outcomes for 1,233 ventilator periods. Periods were included between April and December 2022 for any ventilated patient lasting at least 4 days. National Health Care Safety Network VAE criteria were used to surveille the patient data. Triggers were based on the positive end-expiratory pressure increases or fraction of inspired oxygen (FiO₂) increases. The preset weaning criteria was a reduction by 2 cmHO per 24 hours.
Of the total 1,233 individual ventilator periods, VAE criteria were met in 10%. Of the total 126 periods with VAE, 39.2% met the criteria for appropriate protocol implementation. There was a statistically significant relationship between VAE identification and implementation of the protocol.
The implementation of a protocol for ventilator weaning affects the outcome of developing a VAE. The findings emphasize the importance of implementing the ARDS weaning protocol as a template to reduce the triggers for VAEs and improve overall patient outcomes.
急性呼吸窘迫综合征（ARDS）是一种严重且危及生命的疾病，可发生于重症患者。机械通气是 ARDS 患者常用的干预措施，但患者脱机率具挑战性。ARDSnet 样通气机脱机方案的实施旨在减少与通气相关事件（VAEs）相关的触发因素。
新方案的实施用于对 1233 个通气期的患者结局进行回顾性调查。2022 年 4 月至 12 月期间，任何持续至少 4 天的通气患者均纳入该研究。使用国家医疗保健安全网络（National Health Care Safety Network，NHSN）VAEs 标准监测患者数据。触发因素基于呼气末正压（positive end-expiratory pressure，PEEP）或吸入氧分数（fraction of inspired oxygen，FiO₂）的增加。预设的脱机标准是每 24 小时降低 2 cmHO。
在总共 1233 个单独的通气期中，有 10%符合 VAE 标准。在总共 126 个出现 VAE 的期中，有 39.2%符合方案实施的适当标准。VAEs 的识别与方案的实施之间存在统计学显著关系。
通气机脱机方案的实施会影响 VAE 的发生。研究结果强调了实施 ARDS 脱机方案作为模板来减少 VAEs 触发因素和改善整体患者结局的重要性。
