Curley M A, Fackler J C
Children's Hospital, Boston, Mass., USA.
Am J Crit Care. 1998 Sep;7(5):335-45.
The purpose of the study was to describe the patterns of weaning from mechanical ventilation in young children recovering from acute hypoxemic respiratory failure.
Decision-making rules on progressive weaning were developed and applied to existing data on 82 patients 2 weeks to 6 years old in the Pediatric Acute Respiratory Distress Syndrome Data Set.
Three patterns of weaning progress were detected: sprint, consistent, and inconsistent. Length of ventilation and weaning progressively increased from the sprint, to the consistent, to the inconsistent subset. Patients in the inconsistent subset were most likely to have a systemic (sepsis or shock) trigger of acute respiratory distress syndrome and to be rated as having at least moderate disability at discharge. Hypothesis-generating univariate and then multivariate logistic regression analyses indicated that patients who experienced more days of mechanical ventilation before the start of weaning and who had a higher oxygenation index during the weaning process were most likely to have an inconsistent pattern of weaning.
Patterns of weaning are discernible in a population of young children and indicate a subset at risk for inconsistent weaning. Knowing the patterns of weaning may help clinicians anticipate, perhaps plot, and then modulate a patient's weaning trajectory.
本研究旨在描述急性低氧性呼吸衰竭康复期幼儿机械通气撤机模式。
制定了逐步撤机的决策规则，并应用于儿科急性呼吸窘迫综合征数据集里82例2周龄至6岁患者的现有数据。
检测到三种撤机进展模式：快速、持续和不持续。通气时长和撤机时间从快速模式组到持续模式组，再到不持续模式组逐渐增加。不持续模式组的患者最有可能因全身性（脓毒症或休克）因素引发急性呼吸窘迫综合征，且出院时至少被评定为中度残疾。单变量及后续多变量逻辑回归分析提示，撤机开始前机械通气天数较多且撤机过程中氧合指数较高的患者最有可能出现不持续撤机模式。
幼儿群体中存在撤机模式，且表明存在撤机不持续风险的亚组。了解撤机模式可能有助于临床医生预测，或许还能规划并调整患者的撤机进程。
