Weaning patients off mechanical ventilation in a chronic ventilation facility – using a standardised approach

IF 1.6 Q2 ANESTHESIOLOGY
P. V. van Heerden, Eleonora Krugman, Estelle Bouhnish
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Abstract

Background We describe the standardised management of patients in a chronic ventilation facility (CVF) and the rate of weaning of chronically ventilated patients off mechanical ventilation. This population of patients is transferred from acute care facilities where they have been deemed “non-weanable” and require prolonged ventilation. Methods Admissions to our CVF were audited over a period of 3 years. We collected demographic and outcome data as well as the patients’ length of stay and disposition. Weaning in our centre proceeds step-wise with a reduction in the adaptive support ventilation (ASV) minute ventilation target. Once the target reaches 50% of minute ventilation, spontaneous breathing trials are introduced and progressively lengthened until the patient is weaned. Results In total, 125 patients were admitted during the 3 years. 109 were not weaned, and 16 were weaned, i.e. 12.8% of patients were safely weaned off mechanical ventilation. Of the patients not weaned, the mortality rate was 34.8%, and 38.5% were discharged alive to either home or another facility. Conclusions Weaning chronically ventilated patients is possible without intensivists or respiratory therapists on staff when a standardised approach/manner is implemented. However, weaning success appears to be mainly related to patients’ co-morbidities.
在慢性通气设施中使患者脱离机械通气-使用标准化方法
我们描述了慢性通气设施(CVF)患者的标准化管理和慢性通气患者脱离机械通气的脱机率。这些患者是从被认为“不能断奶”并需要长时间通气的急症护理机构转过来的。方法对我们CVF的入院进行为期3年的审计。我们收集了人口统计和结果数据,以及患者的住院时间和处置情况。在我们的中心,随着自适应支持通气(ASV)分钟通气目标的减少,逐步进行断奶。一旦目标达到每分钟通气的50%,就开始进行自主呼吸试验,并逐渐延长试验时间,直到患者脱机。结果3年内共收治125例患者。109例未脱机,16例脱机,即12.8%的患者安全脱机。在未断奶的患者中,死亡率为34.8%,38.5%的患者活着出院到家中或其他机构。结论:如果采用标准化的方法/方式,慢性通气患者可以在没有重症监护医师或呼吸治疗师的情况下脱机。然而,断奶成功似乎主要与患者的合并症有关。
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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
48
审稿时长
25 weeks
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