有创机械通气患者撤机结局预测指标的研究进展
Research Progress on Predictive Indictors of Weaning Outcomes in Patients with Invasive Mechanical Ventilation
DOI: 10.12677/acm.2024.1441208, PDF,   
作者: 赵 辉, 陈雪梅*:重庆医科大学附属第一医院重症医学科,重庆
关键词: 呼吸机撤机撤机结局预测指标Weaning from Mechanical Ventilation Weaning Outcome Predictive Indicators
摘要: 有创机械通气技术的发展使得危重患者救治率大大提升,但呼吸支持的最终目的是使患者撤离呼吸机并实现自主呼吸。因此,撤机前的准确评估尤为重要。目前已经报道的撤机前评估指标如浅快呼吸指数、最大吸气压力、呼吸功等,均存在一定的局限性,近年来一些新的预测指标逐渐被报道。本文就目前国内外预测危重患者撤机结局的最新指标进行综述,结果显示尚无公认的最优预测指标,联合多种指标的人工智能辅助决策有望为临床提供帮助,以提高危重患者撤机的成功率。
Abstract: The development of invasive mechanical ventilation technology has greatly improved the treatment rate of critically ill patients, but the ultimate goal of respiratory support is to enable critically ill patients to successfully evacuate the artificial airway and achieve autonomous breathing. Therefore, accurate evaluation before withdrawal is particularly important. At present, it is reported that some evaluation indicators such as rapid breathing index, maximum inspiratory pressure, respiratory work, etc., all of them have certain limitations. In recent years, some new predictive indictors were gradually reported. In this paper, we reviewed recent studies about indicators in predicting the outcome of weaning from mechanical ventilation in critically ill patients both home and abroad, found that there is no recognized optimal predictor. The AI-assisted decision making combined with multiple indicators is expected to provide help for accurate assessment before weaning from invasive mechanical ventilation, thus improving weaning outcome.
文章引用:赵辉, 陈雪梅. 有创机械通气患者撤机结局预测指标的研究进展[J]. 临床医学进展, 2024, 14(4): 1670-1674. https://doi.org/10.12677/acm.2024.1441208

参考文献

[1] Nascimento, M.S., Rebello, C.M., Vale, L.A.P.A., et al. (2017) Spontaneous Breathing Test in the Prediction of Extubation Failure in the Pediatric Population. Einstein (Sao Paulo), 15, 162-166. [Google Scholar] [CrossRef] [PubMed]
[2] Baptistella, A.R., Sarmento, F.J., Da Silva, K.R., et al. (2018) Predictive Factors of Weaning from Mechanical Ventilation and Extubation Outcome: A Systematic Review. Journal of Critical Care, 48, 56-62. [Google Scholar] [CrossRef] [PubMed]
[3] Almeida, C.M., Lopes, A.J. and Guimarães, F.S. (2020) Cough Peak Flow to Predict the Extubation Outcome: Comparison between Three Cough Stimulation Methods. Canadian Journal of Respiratory Therapy, 56, 58-64. [Google Scholar] [CrossRef] [PubMed]
[4] Chien, J.Y., Lin, M.S., Huang, Y.C.T., et al. (2008) Changes in B-Type Natriuretic Peptide Improve Weaning Outcome Predicted by Spontaneous Breathing Trial. Critical Care Medicine, 36, 1421-1426. [Google Scholar] [CrossRef
[5] Deschamps, J., Andersen, S.K., Webber, J., et al. (2020) Brain Natriuretic Peptide to Predict Successful Liberation from Mechanical Ventilation in Critically Ill Patients: A Systematic Review and Meta-Analysis. Critical Care, 24, Article No. 213. [Google Scholar] [CrossRef] [PubMed]
[6] Jia, D., Wang, H., Wang, Q., et al. (2024) Rapid Shallow Breathing Index Predicting Extubation Outcomes: A Systematic Review and Meta-Analysis. Intensive and Critical Care Nursing, 80, Article ID: 103551. [Google Scholar] [CrossRef] [PubMed]
[7] Dres, M., De Abreu, M.G., Merdji, H., et al. (2022) Randomized Clinical Study of Temporary Transvenous Phrenic Nerve Stimulation in Difficult-to-Wean Patients. American Journal of Respiratory and Critical Care Medicine, 205, 1169-1178. [Google Scholar] [CrossRef
[8] Fazio, S.A., Lin, G., Cortés-Puch, I., et al. (2023) Work of Breathing during Proportional Assist Ventilation as a Predictor of Extubation Failure. Respiratory Care, 68, 1049-1057. [Google Scholar] [CrossRef] [PubMed]
[9] Sato, R., Hasegawa, D., Hamahata, N.T., et al. (2021) the Predictive Value of Airway Occlusion Pressure at 100Msec (P0.1) on Successful Weaning from Mechanical Ventilation: A Systematic Review and Meta-Analysis. Journal of Critical Care, 63, 124-132. [Google Scholar] [CrossRef] [PubMed]
[10] Bickenbach, J., Fritsch, S., Cosler, S., et al. (2023) Effects of Structured Protocolized Physical Therapy on the Duration of Mechanical Ventilation in Patients with Prolonged Weaning. Journal of Critical Care, 80, Article ID: 154491. [Google Scholar] [CrossRef] [PubMed]
[11] Koyama, Y., Yoshida, T., Uchiyama, A., et al. (2017) Monitoring Diaphragm Function in A Patient with Myasthenia Gravis: Electrical Activity of the Diaphragm vs. Maximal Inspiratory Pressure. Journal of Intensive Care, 5, Article No. 66. [Google Scholar] [CrossRef] [PubMed]
[12] Zhang, R., Xu, X., Chen, H., et al. (2023) Predicting Extubation in Patients with Traumatic Cervical Spinal Cord Injury Using the Diaphragm Electrical Activity During A Single Maximal Maneuver. Annals of Intensive Care, 13, Article No. 122. [Google Scholar] [CrossRef] [PubMed]
[13] Parada-Gereda, H.M., Tibaduiza, A.L., Rico-Mendoza, A., et al. (2023) Effectiveness of Diaphragmatic Ultrasound as a Predictor of Successful Weaning from Mechanical Ventilation: A Systematic Review and Meta-Analysis. Critical Care, 27, Article No. 174. [Google Scholar] [CrossRef] [PubMed]
[14] Xu, Q., Yang, X., Qian, Y., et al. (2022) Comparison of Assessment of Diaphragm Function Using Speckle Tracking between Patients with Successful and Failed Weaning: A Multicentre, Observational, Pilot Study. BMC Pulmonary Medicine, 22, Article No. 459. [Google Scholar] [CrossRef] [PubMed]
[15] Kuriyama, A., Jackson, J.L. and Kamei, J. (2020) Performance of the Cuff Leak Test in Adults in Predicting Post-Extubation Airway Complications: A Systematic Review and Meta-Analysis. Critical Care, 24, Article No. 640. [Google Scholar] [CrossRef] [PubMed]
[16] Wang, W., Zhou, Y., Tong, H.S., Su, L. and Zhao, L. (2015) Value of the Cuff Leak Test Is Limited. Critical Care, 19, Article No. 446. [Google Scholar] [CrossRef] [PubMed]
[17] Tokunaga, K., Ejima, T., Nakashima, T., et al. (2022) A Novel Technique for Assessment of Post-Extubation Airway Obstruction Can Successfully Replace the Conventional Cuff Leak Test: A Pilot Study. BMC Anesthesiology, 22, Article No. 38. [Google Scholar] [CrossRef] [PubMed]
[18] Tsai, W.W., Hung, K.C., Huang, Y.T., et al. (2023) Diagnostic Efficacy of Sonographic Measurement of Laryngeal Air Column Width Difference for Predicting the Risk of Post-Extubation Stridor: A Meta-Analysis of Observational Studies. Frontiers in Medicine, 10, Article 1109681. [Google Scholar] [CrossRef] [PubMed]
[19] Duan, J., Zhang, X. and Song, J. (2021) Predictive Power of Extubation Failure Diagnosed by Cough Strength: A Systematic Review and Meta-Analysis. Critical Care, 25, Article No. 357. [Google Scholar] [CrossRef] [PubMed]
[20] Norisue, Y., Santanda, T., Nabeshima, T., et al. (2021) Association of Diaphragm Movement During Cough, as Assessed by Ultrasonography, with Extubation Outcome. Respiratory Care, 66, 1713-1719. [Google Scholar] [CrossRef] [PubMed]
[21] O’Neill, M.P. and Gopalan, P.D. (2020) Endotracheal Tube Cuff Pressure Change: Proof of Concept for a Novel Approach to Objective Cough Assessment in Intubated Critically Ill Patients. Heart & Lung, 49, 181-185. [Google Scholar] [CrossRef] [PubMed]
[22] Sanfilippo, F., Di Falco, D., Noto, A., et al. (2021) Association of Weaning Failure from Mechanical Ventilation with Transthoracic Echocardiography Parameters: A Systematic Review and Meta-Analysis. British Journal of Anaesthesia, 126, 319-330. [Google Scholar] [CrossRef] [PubMed]
[23] Quintard, H., L’Her, E., Pottecher, J., et al. (2019) Experts’ Guidelines of Intubation and Extubation of the ICU Patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-Speaking Intensive Care Society (SRLF): In Collaboration with the Pediatric Association of French-Speaking Anaesthetists and Intensivists (ADARPEF), French-Speaking Group of Intensive Care and Paediatric Emergencies (GFRUP) and Intensive Care Physiotherapy Society (SKR). Annals of Intensive Care, 9, Article No. 13. [Google Scholar] [CrossRef] [PubMed]
[24] Baptistella, A.R., Mantelli, L.M., Matte, L., et al. (2021) Prediction of Extubation Outcome in Mechanically Ventilated Patients: Development and Validation of the Extubation Predictive Score (ExPreS). PLOS ONE, 16, e0248868. [Google Scholar] [CrossRef] [PubMed]
[25] Menguy, J., De Longeaux, K., Bodenes, L., Hourmant, B. and L’Her, E. (2023) Defining Predictors for Successful Mechanical Ventilation Weaning, Using a Data-Mining Process and Artificial Intelligence. Scientific Reports, 13, Article No. 20483. [Google Scholar] [CrossRef] [PubMed]
[26] Huang, K.Y., Hsu, Y.L., Chen, H.C., et al. (2023) Developing a Machine-Learning Model for Real-Time Prediction of Successful Extubation in Mechanically Ventilated Patients Using Time-Series Ventilator-Derived Parameters. Frontiers in Medicine, 10, Article 1167445. [Google Scholar] [CrossRef] [PubMed]
[27] Liao, K.M., Ko, S.C., Liu, C.F., et al. (2022) Development of an Interactive AI System for the Optimal Timing Prediction of Successful Weaning from Mechanical Ventilation for Patients in Respiratory Care Centers. Diagnostics, 12, Article 975. [Google Scholar] [CrossRef] [PubMed]