|
A background ventilator support is an important means of rescue in critically ill patients with respiratory failure, when respiratory failure caused by the primary disease under control, the doctor should actively assess the patient's condition, and to consider the possibility of weaning. The timely withdrawal functioning reduce ventilator-associated complications and improve the success rate. Some patients for various reasons, weaning failure or weaning time (more than 48-72 hours), scholars such patients as patients with difficult weaning. Patients with difficult weaning weaning weaning strategy depends largely on. Different weaning strategies are mainly two aspects, namely efficiency, both in performance. Difficult weaning strategies for weaning patients remains controversial in the international. In the country, weaning only stay in the mode of comparison, there was no strategy for the difficult weaning patients weaning. Ventilator weaning with the experience of the clinician, the lack of standardization strategy, and to some extent limit the survival rate of critically ill patients. To investigate the efficiency of the difficult weaning patients with different weaning strategies, performance differences and patient adherence to different weaning strategies, we designed this study. The aim of the present study was designed to compare the difficult withdrawal machine in patients with different weaning strategies: (1) Pressure Support (PSV) weaning: u) and synchronized intermittent mandatory ventilation 10 Pressure Support (of magic ** Chung-SV) weaning; mortar) weaning, including T-tube weaning weaning, continuous positive airway pressure (CPAP), synchronized intermittent mandatory ventilation (SIMV) weaning its efficiency, performance differences of the two, and its guidance on clinical significance. Focused on PSV weaning concrete steps on how to set the level of the initial pressure and gradually decreased stress levels. Square dispel difficult withdrawal machine thinking inclusion criteria: patients through comprehensive treatment to meet; Dfo bed weaning weaning ready, but one of the following occurs embarrass weaning patients () weaning test defeat or () weaning time (more than 48 - 72 hours). Then will be difficult weaning patients were randomly divided into three groups, according to the different weaning strategies for weaning: () PSV group; (2) SIMV + PSV group; () other groups, including the T-tube method, CPAP way, SIMV. Compare different weaning strategies weaning to 14 days of starting R performance, efficiency. PSV withdrawal unit, first set the initial pressure level (Baseline PS), the Baseline the PS require adjustment to patients with RR (25-30 bPm V; 35-8 PI Guarana g, then gradually reduced according to whether the patient tolerated pressure support (PS ) level gradually decreased the amplitude of PS 20% of Baseline PS 2-4cmH. O, down 20% every 0.5-1 hours daily drop PS 2 more times. SIMV + PSV withdrawal unit, first set up in early starting frequency and Baseline PS, the initial frequency is the frequency of 80% of the A / C, as appropriate, according to whether the patient tolerated gradually decreased initial frequency, lower and lower SuperStack 3 Baseline PS to 2-4 times / min, the other groups: T tube withdrawal machines, CPAP weaning gradually extended time of T-tube support, SIMV weaning is set the initial frequency of 80% of the A / C frequency gradually decreased, as appropriate, the initial frequency of fourteen, the result of three groups of patients the nature of the base case in the beginning of the withdrawal train yard, such as age, the number of cases of COPD, weaning ventilator support time, respiratory rate, tidal volume, rapid shallow breathing index, minute ventilation oxygenation index no significant difference ( P> 0.05). different weaning strategies efficiency resulting in a significant difference (P <0.05), PSV weaning SIMV + PSV weaning efficient. 3 different weaning strategies used to compare the performance the Kaplan-M. ie. calculated different withdrawal machine strategy over time extension enamel of not withdraw probabilities, the PSV an integral power of 75%, 76.9% SIMV + the PSV composed of power, 40% of the other composed of power, the results compare no significant differences (P> 0.05). PSV weaning SIMV + PSV weaning patients lost to visit a few good compliance; weaning the Cardiff visit to a number of poor compliance. V. Conclusion weaning to set the level of the initial pressure 1.PSV Baseline PS to the patient RR $ 25 - 30bern [V; 35 -8 ml melon g, clinically effective and feasible. gradually decreased, as appropriate, 20% of the Baseline PS to complete weaning, weaning efficiency is a safe, simple, patient compliance good weaning strategy. 2 In this study, strategic weaning is superior to the traditional weaning, suggesting that strategic weaning a comprehensive assessment of the patients on proper weaning timing is important, and confirmed that dynamic observation of rapid shallow breathing index (f / VT ) strategic weaning indicators.
|