自主呼吸试验:如何进行,持续多久?

IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE
Arnaud W Thille, François Arrivé, Sylvain Le Pape
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引用次数: 0

摘要

审查目的:指南建议在 ICU 拔管前系统地进行自主呼吸试验(SBT),目的是降低再次插管的风险。从理论上讲,使用 T-piece进行更具挑战性的 SBT 可进一步降低再次插管的风险,而使用压力支持通气(PSV)进行挑战性较低的 SBT 可加速拔管:最新研究结果表明,使用 T-piece或持续时间较长的高难度 SBT 无助于降低再次插管的风险。相比之下,使用 PSV 的难度较低的 SBT 比使用 T 型气管插管更容易通过,并且可以加快拔管,而不会增加再次插管的风险。虽然使用 PSV 和额外的呼气末正压的 SBT 确实是一种难度较低的 SBT,但要在日常实践中推广这种简单的试验还需要进一步的研究。在不增加再次插管风险的情况下,更早地进行首次 SBT 筛选也可缩短拔管时间。最后,在 SBT 成功后短时间内重新连接呼吸机有助于从 SBT 引起的肺泡扩张中恢复过来。摘要:最近的几项临床试验改进了对拔管前进行 SBT 的最适当方法的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Spontaneous breathing trials: how and for how long?

Purpose of review: Guidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.

Recent findings: Recent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.

Summary: Several recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.

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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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