Saura P, Blanch L, Mestre J, Vallés J, Artigas A, Fernández R
Intensive Care Department, Hospital de Sabadell, Sabadell, Spain.
Intensive Care Med. 1996 Oct;22(10):1052-6. doi: 10.1007/BF01699227.
To analyze the clinical and economic consequences of the implementation of a weaning protocol in patients mechanically ventilated (MV) for more than 48 h.
Comparative study.
General intensive care unit (ICU) in a county hospital covering 360000 inhabitants.
51 patients weaned by a fixed protocol were studied prospectively and compared with 50 retrospective controls.
The following variables were assessed: Acute Physiology and Chronic Health Evaluation (APACHE) II score, age, cause of respiratory failure, type of extubation (direct extubation or extubation using a weaning technique), number of days on MV before the weaning trial, weaning time, total duration of MV, complications (reintubations and tracheostomies), length of ICU stay, and mortality.
The groups were comparable in terms of age, APACHE II score, and main cause of acute respiratory failure. Number of days on MV up to the weaning trial were similar in the two groups (8.4 +/- 7.7 in the protocol group vs 7.5 +/- 5.5 in the control group, NS). Most of the patients (80%) in the protocol group were directly extubated without a weaning technique, unlike the control group (10%) (p < 0.01). When a weaning technique was used, the weaning time was similar in both groups (3.5 +/- 3.9 days vs 3.6 +/- 2.2 days in the control group). Duration of MV was shorter in the protocol group (10.4 +/- 11.6 days) than in the control group (14.4 +/- 10.3 days) (p < 0.05). As a result, the ICU stay was reduced by using the weaning protocol (16.7 +/- 16.5 days vs 20.3 +/- 13.2 days in the control group, p < 0.05). We found no differences in reintubation rate (17 vs 14% in the control group) and need for tracheostomies (2 vs 8% in the control group).
The implementation of a weaning protocol decreased the duration of MV and ICU stay by increasing the number of safe, direct extubations.
分析对机械通气（MV）超过48小时的患者实施撤机方案的临床和经济后果。
对比研究。
一家为36万居民服务的县级医院的综合重症监护病房（ICU）。
对51例按固定方案撤机的患者进行前瞻性研究，并与50例回顾性对照患者进行比较。
评估以下变量：急性生理与慢性健康状况评分系统（APACHE）II评分、年龄、呼吸衰竭病因、拔管类型（直接拔管或采用撤机技术拔管）、撤机试验前MV天数、撤机时间、MV总时长、并发症（再次插管和气管切开）、ICU住院时长及死亡率。
两组在年龄、APACHE II评分及急性呼吸衰竭主要病因方面具有可比性。两组撤机试验前的MV天数相似（方案组为8.4±7.7天，对照组为7.5±5.5天，无统计学差异）。与对照组（10%）不同，方案组大多数患者（80%）直接拔管，未采用撤机技术（p<0.01）。采用撤机技术时，两组撤机时间相似（方案组为3.5±3.9天，对照组为3.6±2.2天）。方案组的MV时长（10.4±11.6天）短于对照组（14.4±10.3天）（p<0.05）。因此，采用撤机方案可缩短ICU住院时长（方案组为16.7±16.5天，对照组为20.3±13.2天，p<0.
