Aldrich T K, Uhrlass R M
Crit Care Med. 1987 Mar;15(3):247-9.
An 18-yr-old man with Duchenne muscular dystrophy and ventilatory failure could not be weaned from mechanical ventilation using a T-piece method, despite repeated attempts over 3 months. Subsequently, we weaned the patient using inspiratory muscle resistive training (IRT), modified by the concurrent delivery of intermittent mandatory ventilation (IMV). During the training program, the sessions were gradually prolonged from 5 min to a maximum of 30 min, the IMV rate was gradually decreased, and the magnitude of the resistive load was gradually increased. After 45 days of training, his vital capacity had increased from 380 to 850 ml, his maximal inspiratory airway pressure from -28 to -50 cm H2O, and his tolerance of T-piece breathing, from less than 10 min to over 16 h. After an additional 2 wk of nocturnal mechanical ventilation, he was successfully weaned. We conclude that IRT with IMV can be an effective method of weaning patients who have severe ventilatory failure.
一名患有杜氏肌营养不良症且伴有呼吸衰竭的18岁男性，尽管在3个月内多次尝试，但使用T形管法仍无法撤机。随后，我们采用吸气肌阻力训练（IRT）对该患者进行撤机，并同时给予间歇强制通气（IMV）进行调整。在训练过程中，训练时间从5分钟逐渐延长至最长30分钟，IMV频率逐渐降低，阻力负荷幅度逐渐增加。经过45天的训练，他的肺活量从380毫升增加到850毫升，最大吸气气道压力从-28厘米水柱增加到-50厘米水柱，对T形管呼吸的耐受时间从不到10分钟增加到超过16小时。在夜间机械通气额外进行2周后，他成功撤机。我们得出结论，IRT联合IMV可能是一种有效的为严重呼吸衰竭患者撤机的方法。
