Abstract：
OBJECTIVE: To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016.
METHODS: Post-hoc analysis of four cohort studies.
UNASSIGNED: 138 Spanish ICUs.
METHODS: 2141 patients scheduled extubated.
METHODS: None.
METHODS: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality.
RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435).
CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
METHODS: Post-hoc analysis of four cohort studies.
UNASSIGNED: 138 Spanish ICUs.
METHODS: 2141 patients scheduled extubated.
METHODS: None.
METHODS: Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality.
RESULTS: There was a significant increase (p<0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p=0.435).
CONCLUSIONS: There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.
摘要：
目的：评估1998年至2016年西班牙机械通气断开的变化。
方法：对四项队列研究进行事后分析。
■138个西班牙ICU。
方法：2141名计划拔管的患者。
方法：无。
方法：人口统计，机械通气的原因，并发症,断开的方法，第一次尝试断开连接时失败，断奶时间,再插管,再插管气管切开术,ICU住院时间和死亡率。
结果：使用逐渐降低的支持压力显着增加（p<0.001）。随着时间的推移，使用逐渐减少压力支持与自主呼吸试验的调整概率增加，首次尝试断流(以1998年研究为参考:2004年比值比0.99,2010年比值比0.57,2016年比值比2.43)和困难/长时间断流(以1998年研究为参考:2004年比值比2.29,2010年比值比1.23,2016年比值比2.54).第一次尝试断线后拔管的患者比例随着时间的推移而增加。用于断奶的通风时间有所减少（从1998年的45％减少到2016年的36％）。然而,困难/长时间断奶的持续时间没有减少(所有研究中的中位数为3天，p=0.435）。
结论：机械通气的断开方式发生了重大变化，随着压力支持的使用逐渐增加，压力支持逐渐减少。没有观察到结果的相关变化。
方法：对四项队列研究进行事后分析。
■138个西班牙ICU。
方法：2141名计划拔管的患者。
方法：无。
方法：人口统计，机械通气的原因，并发症,断开的方法，第一次尝试断开连接时失败，断奶时间,再插管,再插管气管切开术,ICU住院时间和死亡率。
结果：使用逐渐降低的支持压力显着增加（p<0.001）。随着时间的推移，使用逐渐减少压力支持与自主呼吸试验的调整概率增加，首次尝试断流(以1998年研究为参考:2004年比值比0.99,2010年比值比0.57,2016年比值比2.43)和困难/长时间断流(以1998年研究为参考:2004年比值比2.29,2010年比值比1.23,2016年比值比2.54).第一次尝试断线后拔管的患者比例随着时间的推移而增加。用于断奶的通风时间有所减少（从1998年的45％减少到2016年的36％）。然而,困难/长时间断奶的持续时间没有减少(所有研究中的中位数为3天，p=0.435）。
结论：机械通气的断开方式发生了重大变化，随着压力支持的使用逐渐增加，压力支持逐渐减少。没有观察到结果的相关变化。
