评估1998年至2016年西班牙机械通气断开的变化。
四项队列研究的事后分析。
138个西班牙ICU。
2141名患者计划拔管。
无。
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。
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)。
机械通气的断开模式发生了重大变化,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。
To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016.
Post-hoc analysis of four cohort studies.
138 Spanish ICUs.
2141 patients scheduled extubated.
None.
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.
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).
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.