Esteban A, Alía I, Tobin M J, Gil A, Gordo F, Vallverdú I, Blanch L, Bonet A, Vázquez A, de Pablo R, Torres A, de La Cal M A, Macías S
Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain.
Am J Respir Crit Care Med. 1999 Feb;159(2):512-8. doi: 10.1164/ajrccm.159.2.9803106.
The duration of spontaneous breathing trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for trials of spontaneous breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a spontaneous breathing trial did not differ in the 30- and 120-min trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p < 0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the trial, nor other functional measurements before the trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.
在研究中，拔管前自主呼吸试验的时长设定为2小时，但最佳时长尚不清楚。我们进行了一项前瞻性、多中心研究，纳入了526名被认为已准备好撤机的接受机械通气的患者，以比较目标时长分别为30分钟和120分钟的自主呼吸试验的临床结局。在30分钟试验组和120分钟试验组的270例和256例患者中，分别有237例（87.8%）和216例（84.8%）顺利完成试验且未出现不适并成功拔管（p = 0.32）；这些患者中分别有32例（13.5%）和29例（13.4%）在48小时内需要再次插管。在30分钟试验组和120分钟试验组中，自主呼吸试验后48小时仍保持拔管状态的患者百分比无差异（分别为75.9%和73.0%，p = 0.43）。30分钟试验组和120分钟试验组的单位内死亡率（分别为13%和9%）和院内死亡率（分别为19%和18%）相似。61例（13.5%）患者需要再次插管，这些患者的死亡率（61例中的20例，32.8%）高于耐受拔管的患者（392例中的18例，4.6%）（p < 0.001）。试验期间的呼吸频率、心率、收缩压和血氧饱和度测量值，以及试验前的其他功能测量值，均无法区分需要再次插管的患者和耐受拔管的患者。总之，在首次自主呼吸试验后，目标时长为30分钟和120分钟的试验在成功拔管方面效果相当。
