Gluck E H, Barkoviak M J, Balk R A, Casey L C, Silver M R, Bone R C
Chicago Medical School, IL.
Crit Care Med. 1995 Mar;23(3):504-9. doi: 10.1097/00003246-199503000-00015.
To determine the efficacy of a new respiratory monitor, which uses esophageal balloons, in aiding clinicians attempting to wean patients from mechanical ventilation.
Prospective study of patients who were deemed ready to be weaned after having required mechanical ventilation for a minimum of 3 days. Each of the patients served as his or her own control.
University medical intensive care unit.
The series consisted of 23 consecutive patients who were ready to wean from mechanical ventilation.
Before the onset of the study, two weaning strategies were developed. One strategy involved using clinically available weaning parameters. The other strategy involved using esophageal balloon data that was recorded via a new respiratory monitor. Each of the weaning strategies resulted in the development of a scoring system that could be rigidly adhered to and which determined, without bias, to what extent the patient could be weaned each day. Rigid criteria were also developed to determine whether the weaning trial was successful or not. The two strategies were then compared to determine the ability of the strategy to shorten ventilatory time.
Each patient was evaluated daily by the two weaning protocols. At each weaning step, the two protocols were compared with respect to degree of aggressiveness and tolerance of the weaning maneuver by the patient. A protocol was judged superior if it resulted in more aggressive weaning without increased patient intolerance. The clinicians evaluating the patient with the clinical protocol could accelerate or retard the number of weaning steps by one step, based on the patient's clinical state and the clinician's experience. There was no such freedom in the esophageal protocol. The major finding was that in 40.5% of the instances, the protocol involving the esophageal balloon resulted in more aggressive weaning without patient intolerance. In 11.6% of the cases, the clinical protocol was more aggressive. Both protocols predicted the same number of weaning steps 39.8% of the time. In all these instances, the patient tolerated the weaning suggested. The use of data from the esophageal protocol resulted in weaning the patients 1.68 days faster than the use of data from the clinical protocol.
The respiratory monitor, using esophageal balloon technology, is effective in that it can provide the clinician with data that can result in more aggressive weaning from mechanical ventilation without an increase in patient intolerance. The duration of mechanical ventilation can be shortened when these data are applied via a rigidly controlled weaning strategy.
确定一种使用食管气囊的新型呼吸监测仪在帮助临床医生尝试使患者脱离机械通气方面的疗效。
对至少接受3天机械通气后被认为准备好撤机的患者进行前瞻性研究。每位患者均作为自身对照。
大学医学重症监护病房。
该系列包括23例连续的准备从机械通气撤机的患者。
在研究开始前，制定了两种撤机策略。一种策略涉及使用临床上可用的撤机参数。另一种策略涉及使用通过新型呼吸监测仪记录的食管气囊数据。每种撤机策略都形成了一个评分系统，该系统可以严格遵守，并且能无偏差地确定患者每天可以撤机的程度。还制定了严格的标准来确定撤机试验是否成功。然后比较这两种策略，以确定该策略缩短通气时间的能力。
每天通过两种撤机方案对每位患者进行评估。在每个撤机步骤，比较两种方案在撤机操作的激进程度和患者耐受性方面的情况。如果一种方案能在不增加患者不耐受的情况下实现更激进的撤机，则判定该方案更优。使用临床方案评估患者的临床医生可根据患者的临床状态和临床医生的经验，将撤机步骤的数量加快或减慢一步。在食管方案中没有这样的灵活性。主要发现是，在40.5%的情况下，涉及食管气囊的方案能实现更激进的撤机且患者无不耐受。在11.6%的病例中，临床方案更激进。两种方案在39.8%的时间里预测的撤机步骤数量相同。在所有这些情况下，患者都能耐受所建议的撤机。使用食管方案的数据使患者撤机时间比使用临床方案的数据快1.68天。
使用食管气囊技术的呼吸监测仪是有效的，因为它可以为临床医生提供数据，从而在不增加患者不耐受的情况下实现更激进的机械通气撤机。当通过严格控制的撤机策略应用这些数据时，机械通气的持续时间可以缩短。
