Shikora S A, Benotti P N, Johannigman J A
Department of Surgery, Wilford Hall USAF Medical Center, Lackland AFB, Texas.
Arch Surg. 1994 Mar;129(3):269-74. doi: 10.1001/archsurg.1994.01420270045011.
To compare the respiratory rate to tidal volume ratio with the oxygen cost of breathing to see which could more accurately predict the outcome of ventilator weaning for surgical patients.
Prospective comparison of two modalities used to predict the likelihood of successful ventilator weaning.
Twenty-eight consecutive patients with chronic respiratory insufficiency requiring long-term mechanical ventilation in the surgical intensive care unit at New England Deaconess Hospital, Boston, Mass, were studied.
The oxygen cost of breathing and the respiratory rate to tidal volume ratio were measured during spontaneous breathing. Patients extubated within 2 weeks of being studied were designated as extubated while patients not extubated within this period or requiring reintubation were recorded as not extubated.
The oxygen cost of breathing predicted successful extubation in all five patients who were extubated, and failure in 20 of 23 patients who could not be extubated (sensitivity, 100%; specificity, 87%). In contrast, the respiratory rate to tidal volume ratio predicted extubation for only two of five patients who were extubated and predicted failure in only 12 of 23 patients who could not be extubated (sensitivity, 40%; specificity, 52%).
For this group of patients requiring prolonged ventilation, the oxygen cost of breathing proved to be a more reliable predictor of both successful extubation and failure.
比较呼吸频率与潮气量之比和呼吸氧耗，以确定哪一项能更准确地预测外科手术患者撤机的结果。
对两种用于预测撤机成功可能性的方法进行前瞻性比较。
对波士顿马萨诸塞州新英格兰女执事医院外科重症监护病房中连续28例需要长期机械通气的慢性呼吸功能不全患者进行了研究。
在自主呼吸期间测量呼吸氧耗和呼吸频率与潮气量之比。在研究后2周内拔管的患者被认定为已拔管，而在此期间未拔管或需要重新插管的患者则记录为未拔管。
呼吸氧耗预测了所有5例已拔管患者的拔管成功，以及23例未拔管患者中20例的拔管失败（敏感性为100%；特异性为87%）。相比之下，呼吸频率与潮气量之比仅预测了5例已拔管患者中的2例拔管成功，以及23例未拔管患者中的12例拔管失败（敏感性为40%；特异性为52%）。
对于这组需要长时间通气的患者，呼吸氧耗被证明是拔管成功和失败的更可靠预测指标。
