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不同患者机械通气的脱机

Weaning From Mechanical Ventilation in Various Patient Populations: Pathways and Pitfalls
Disclosures
Andrew Shaw, MB, FRCA
Introduction
　　One of the many challenges facing intensive care and perioperative physicians is to successfully separate patients from mechanical ventilation after a period of respiratory failure. The clinical management of weaning patients from mechanical ventilatory support may be characterized in terms of minimizing intensive care unit (ICU) length of stay and reducing morbidity or mortality. It has been estimated that approximately 40% of a patient's total ventilatory time is spent in a weaning mode[1]; thus, any means of reducing this time would appear beneficial. This article reviews those approaches to weaning discussed during the session convened at the 32nd Critical Care Congress in San Antonio, Texas, with emphasis on the use of weaning protocols, neurosurgical patients, and children.
　　The Weaning Process: Traditional Methods of Assessment
　　Table. Criteria for Weaning Patients From Mechanical Ventilation
　　Weaning Pathways and Protocols
　　Neurosurgical Patients
　　Pediatric Issues
Conclusion
　　Despite the advent of modern high-technology monitors, it is still true to say that for adults, protocol-based weaning, when directed by the nurse and respiratory therapist at the patient's bedside, probably has the highest positive predictive value for successful weaning of the patient from a ventilator. This is not the case in children, however. Monitors cannot wean patients, but they do give the clinician at the bedside insight into the patient's respiratory physiology and allow more informed decision-making. Decisions based on accurate data will lead to more aggressive weaning practices and successful extubation on a more consistent basis. For specific subgroups of patients such as neurosurgical patients, general rules may not apply, and these special situations demand a more individualized approach to the problem of weaning and extubation.
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